Individual Dental Insurance, Over charging dentist in Pennsylvania
I am self employed and had to get my own medical and dental insurance. The medical plan that I got came with some dental so I just left it at that. I was told I could go to any dentist I wanted and I would get 80 percent covered for preventive and basic dental care and that for major I would have 40 percent covered.
It also had a $1000 max but since I really have no problems with my teeth I felt this was more then enough. So I go to a dentist and Had my preventive dental care. Which was cleaning X-rays and I guess an office visit charge. Total billing came out to almost 400 but I get 80 percent covered so no big deal right.
Wrong I get the billing and I am told my dentist is over a UCR rate. When I asked want that was I was told my dentist is over the going cost in my area. So I have a $200 bill which I still need to pay. I am upset with this since this is only about 50% and not the 80% percent I thought I was covered for. What is going on here? and what can I do about it?
Tuesday, Dec. 7th 2010 10:20 AM at 10:20 am
Go to a less expensive dentist. $400 for your office visit, X-rays and basic cleaning is crazy. I live in CA which is a costly state and the most I had to pay for those types of dental services is $250
How can you really be shocked that you went over UCR. So unless there were more dental services that was render to get up to the $400 cost I do not see where you should be too upset.
Most PPO plans pay up to UCR (Fair and Reasonable) In order to try and avoid this is by submitted claims prior to work being started so you will know if you are going to fall into a UCR issue before starting your dental work. Then you decide if you want to go head with the cost they will reflect.
Tuesday, Dec. 7th 2010 1:36 PM at 1:36 pm
Your dentist does sound costly. But you have a plan that let you choose your own dentist. UCR are would have been disclosed to you in the plan terms.
Though I know they can be over looked but they are important to know about so that so are not hit by any unexcepted charges.
Tuesday, Dec. 7th 2010 1:48 PM at 1:48 pm
Are you sure what you got was a basic cleaning? Maybe you got a different cleaning ADA code that was more costly. It hard to say that a dentist is over charging because a dentist can charge whatever they want.
That is why before having work done with my plan I know what my dental cost are going to be before any work is started. I also make my dentist submit my treatment plan to my company for approval and so I will know what my true cost are going to be for the services.
This is not such a time process at least not with my dental insurance company they get back normally with the next business day. This is something you may want to start doing.
Wednesday, Dec. 8th 2010 12:15 PM at 12:15 pm
You may want to find a dental HMO insurance plan instead. On an HMO dental insurance plan you do not have to worry about UCR fee for dental services covered under their plans.
Reason being is that an HMO lays out your cost for all the dental services covered on their posted fee schudule. Which lets you know what your true cost for dental services are and not some percentage amount that may inclued UCR cost.