CONSULATE
Consulate Dental Plans, Submitting claims twice.
Question: Over three months ago I had a dental plan treatment that was going to cost $2200.00. My dental insurance company as a maximum limit of $2000.00. Keeping that in mind I paid my dental office at the time services was render $200.00 thinking that should be the end of the matter.
A month later I get a dental billing from the dentist for another $400.00. Another issue I have is that it looks like my dental plan paid the dentist around $1600.00 which should be $2000.00 since that is my max limitation. I an not understanding what is going on here. I tried calling my insurance company but the hold time is over 30 minutes.
I do not want to pay another $400.00 to my dentist when I think they are over charging me or double charging me. Either that or my dental plan is not paying out the claims like they should. Not sure what to do.
Answer: Although I can understand not wanting to be on hold for a long time it is important that you call your insurance company. Try calling first thing in the morning when the company will not be so busy. With that said there are a possible few factors you are forgetting. Such as even if you have a 2000.00 max per person per year, did you take into account any other dental work you may have had done to reduce the max limitation that was left?
Also remember major service are still only paid about up to a certain percent. The norm for major dental services is 50 -60 percent which means you would still have 50 – 40 percent to pay as your co-payment under the plan. In addition most PPO plans still only pay up to UCR (what is fair and reasonable in your area) you may have also be dealing with UCR fees. That is why you do need to take the time and call your dental insurance company. This does not sound like a case where the dentist office is billing twice nor does it sound as if the company is not paying out correctly. It is more of a case of you not fully understanding your policy terms and limitations.