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Dental care, Feeling a little riped off from my dentist.

A few year ago I was in a bike accident where I broke a few of my front teeth.   Three teeth were chipped and one was cracked.   At the time I did not have any dental insurance. So I could not really do anything about it.

Now I have dental insurance though work and I was told that I could use the plan for fixing up my teeth. I went to a dental office that my insurance company refer me to as a plan dentist in their PPO network.

When I went to see the dentist they quoted me $3500.00 to fix up my teeth.  My dental insurance was going to pay %50 of the bill.  However by the time all things were said and done my cost was  $2500.00.  As you can see then numbers are not adding up.    I think the dentist is over charging from what he told me the cost is going to be.

I just got this bill in the mail today and a corse the dental office is closed for a week  do to some construction work going on.  Up set about this whole matter need advise so when I call the dental office to find out what is going on I will know what to say.

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Posted on Thursday, Jul. 22nd 2010 9:27 AM | by Dental | in Dental help, Dental Insurance, Dentists | 2 Comments »

2 Comments on “Dental care, Feeling a little riped off from my dentist.”

  1. Caroline jackey Says:

    You did not state but did you by chance go over your yearly max limit?

    As an quick example: If you have a max limit of $1000 per person per year then send a billing for $3500.00 with %50 co pay you would go over your max limit by $750.00.

    At that point the insurance company instead of paying $1750.00 50% of the $3500.00 would only pay the max limit of $1000.00 leaving you at the $2500.00

    Reading what you wrote that is how I would have back into what was said to get to $2500.00 billing now due.

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  2. Andrew Gollab Says:

    Carol is right on assuming your dental insurance plan has a $1000.00 year max limit. However, we do not know since you do not state what your max limit is so let’s assume you have a $2000.00 max limit then coverage being a 50% you may think then you would get the full $1750.00 (50% of $3500.00) covered. Since after all it did not excess your yearly max.

    However, one only needs to have gotten suck with UCR fees to know that you may not always get the coverages you think you should.

    UCR fees are what the insurance company will determine is Fair and Reasonable in one given area. Your dentist may say the charge is $3500.00 for the work he is doing. However that does not mean his pricing is within the fair and reasonable guide lines the insurance company may have set up.

    After reviewing your claim the dental insurance company may have said well only $2000.00 is the fair and reasonable cost for the dental service you had.

    That being the case they would have paid the 50% off of the $2000.00 they determine was the UCR or fair and reasonable rate. Hence leaving you with the remaining $2500.00

    To avoid this from happening to you in the future you would want to submit the claims for approval before having any dental work done. That way you know your total cost for the dental services before committing to anything.

    Both mine and Caroline’s examples, are just examples of what could have taken place. I would talk to the insurance company first and find out the reason for the adjusted difference, before getting upset with your dentist.

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