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Dental insurance coverages, Dental claims

Sunday, Aug. 8th 2010 9:53 AM

So I have a dental PPO plan I get though my job.  What I do not understand is how my dental insurance states my coverages are one thing but when a claim is filed the number so not add up.  For an example of what I me.  Not that long ago I had a large filling and a crown put on.  The filling coverages where to be at 80 percent paid.  Which it was so that was fine

However the crown I got cot $1000.00 and my plan said that it paid out 50 percent for the cost of a crown.  Straight forward math right I should only have to pay 500.00 which was my 50 percent.  Now I get the billing from the dental office stating the insurance company only paid out 450.00 so my cost is $550.00 now it is only $50.00 more but this happens quite a lot. What should I do about this?

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Posted on Sunday, Aug. 8th 2010 9:53 AM | by admin | in Dental Help, Dental Insurance | 2 Comments »

2 Comments on “

Dental insurance coverages, Dental claims

  1. Carol Says:

    Off hand it seems as if you are getting UCR charges. Your dental insurance company pays up to 50% of majors however, normally only what they feel is fair and reasonable cost for the dental service. You should call your dental insurance company and confirm this.

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  2. Lenny Says:

    Yea so sounds like UCR fee to me too. I would get hit with them all the time. I had to change my dentist just so that I would not get extra billing sent to me all the time.

    One way to know in advance though is to submit your claims as quotes only and have the insurance company tell you first how much they are going to pay. Then you can make up your mind if you want to still get the work done.

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