How staying in-network with Beam helps you save money

When it’s time to schedule a dental appointment, one of the first things that may come to mind is, “How much will I pay out of pocket?” The price of dental procedures will vary based on several key factors, including the work being done, location, and if the provider is covered within a benefits plan.

Beam Benefits offers preferred provider organization, commonly referred to as PPO, plans. A PPO plan is a network of healthcare providers that can be used for medical care. In this case, Beam’s PPO plans offer members access to a nationwide network of dental professionals with lower contracted rates. Additionally, Beam may also cover a higher percentage of the cost when members stay in-network (INN), depending on the plan.

However, members are not limited to visiting only providers in-network. Beam offers out-of-network (OON) benefits to offset the costs associated with visiting a dental professional that’s not within a network.

The guide below breaks down how the process works when visiting a provider and the differences between staying in-network and going out-of-network.

1. Schedule an appointment

Check to see if a dental professional is in the Beam provider network. This can be confirmed by contacting the dental office or using our Find a Dentist tool to verify.

2. You undergo a procedure, and the dentist submits a claim

Following the appointment, a member will pay a deductible based on if it’s required by the plan before it’s submitted as a claim to Beam.

3. Beam receives and processes the claim

Here’s where things start to differ based on whether a member chooses an INN or OON provider.

In-network provider: once Beam receives a claim and determines whether the provider is in-network, we’ll apply coinsurance based on the type of procedure received and the dental plan. Coinsurance is the percentage of a covered service a member responsible for paying. Here are a couple of examples* to illustrate how this works:

• If you receive a dental cleaning, you likely won’t owe anything — most Beam plans cover diagnostic and preventative services at 100% and waive the deductible for these procedures.
• If you get a filling that’s covered at 80% under your plan, you’ll owe the remaining 20% plus a deductible if it hasn’t been met yet.

Out-of-network provider: we’ll apply coinsurance based on whether a member has a UCR (Usual, Customary, and Reasonable) or MAC (Maximum Allowable Cost) plan. You can see which one you have in your benefits summary, which you can access at app.beambenefits.com. We know UCR and MAC plans are a little confusing, so check out our comprehensive breakdown!

4. Beam provides an explanation of benefits and sends their payment to your provider

Members will receive an explanation of benefits from us in the mail or via email. This document outlines the cost of the procedure, what the dentist charged, what we paid on the members’ behalf, and what is owed. The dentist will also receive the same document. Note that this is not a bill.

In-network provider: the provider will reach out if any balance is owed. However, there’s a good chance a member will not owe anything when they stay in-network for diagnostic and preventative services (e.g., exams, cleanings, X-rays). Under some Beam plans, basic services such as root canals and fillings are covered at 100% as well, although you may still owe a deductible.*

Out-of-network provider: while we offer strong out-of-network coverage that can cover the full cost in some situations, that won't always be the case. The dental office will reach out to the member for the remaining balance owed.

Members likely won’t encounter significant out-of-pocket costs when visiting an out-of-network provider, but in some cases, staying in-network is the most cost-effective option. If you have any questions about Beam’s dental benefits, give us a call at (800) 648-1179 or email support@beambenefits.com