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Dental Benefit – How do I make sure that my dental work is covered.

Wednesday, Sep. 28th 2022 8:54 AM

I need to have three filling and one crown for a cracked back molar.  I do have dental insurance but when I ask the dental office staffing what I am covered for and for how much they do not seem to know or will not give me a direct answer.  

I told the counter girl that I do not what to have any dental work done that I am not going to be covered for.  I was told that my policy pay on a percent of my dental services however they do not know the final billing until after my insurance company pays the bill.  Then they will charge me any remaining differences.   Well this does not work for me.  What happen if I get stuck with a bill I can not afford to pay.  This dental office does not offer a billing plan so I would need to pay the bill off when I get it.  I want to know a head of time.  Is this possible or do I have to hope that the bill stays low enough for me to pay.  

Reply: Dental office will normally not say this is the dollar amount you would have to pay them based only on your policy coverage’s.   The reason for this is that they know there are sometime UCR fees. Your insurance company will normally only pay out to what they feel is fair and reasonable in your area.  

As an example: Your plan may says that they cover out 50% for the cost of a crown. But they may say that the UCR rate for a crown is 600.00 However your dentist charges 800.00 what will happen in this case is that your dental insurance company will pay out 50% of the $600.00 leaving you not only the $300.00 but the remaining $200.00 that the company did not cover out for.  

You can see by that example why a dental office would not be able to confirm exact cost to you. Now what you can do is before having any dental work done is that you submit a dental treatment plan to your insurance company as a quote only.   That way before having any dental services render your insurance company can confirm to you your coverage amount. I am surprised that your dental office did not suggest this to you

Posted on Wednesday, Sep. 28th 2022 8:54 AM | by carol | in Dental Benefits | No Comments »

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