What Is an Allowable Amount?
An allowable amount is the fee your insurance company uses to calculate benefits for a procedure, which may be different from your dentist’s actual fee. For example, if a crown is $1,200 but the allowable amount is $1,100 and your plan covers 50%, the insurance would pay $550 and you would be responsible for the remaining balance.
In-Network vs. Out-of-Network
If you have a PPO dental insurance plan, you have the freedom to choose the dentist that is right for you, not just one who is in your insurance network. The main difference between in-network and out-of-network benefits is often the fee structure. In-network dentists agree to contracted fees and terms set by the insurance company, while out-of-network benefits are typically based on the insurance company’s allowable fees. Depending on your specific plan, many patients still receive significant, and many times even the same, insurance benefits when seeing an out-of-network provider.
At 1460 Dental Studio, we believe your treatment decisions should be based on your oral health needs, not insurance limitations. That’s why we are selective about the insurance plans we participate with, allowing us to provide the high-quality, personalized care our patients deserve without cutting corners on materials, labs, or the time we spend with you. In fact, many of our patients choose to see us over in-network offices because they value our honesty, attention to detail, and commitment to doing what’s best for their long-term oral health. Our team will gladly verify your benefits, file claims on your behalf, and provide transparent estimates so you can focus on your smile—not the paperwork.