Salman asked in Business & FinanceInsurance · 1 decade ago

Dentist charges a copay and after insurance provider pays less than submitted, charges the rest amount to me?

I went to a dentist, got some cavity fillings (9) and deep cleaning done.

They said my co-pay was $232

After 10 days i receive a letter saying,

the total amount for service: $2772

Insurance paid: $1215

Patient paid: $232.

Hence they ask me to pay the remaining amount of $1325.

I don't want to pay? What are the options?

If it was so much, i wouldn't have gone for it

I have attached the Explanation of Benefits in the below link (totally 3):

img8. imageshack. us / g / eob1. jpg /

Update:

PS: Having problem in posting a link, hence with spaces...

9 Answers

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  • 1 decade ago
    Favorite Answer

    Here is some information about your insurance:

    You are required to pay $50 before the insurance will pay anything (you see this on the first line before the table.

    You have a $2000 annual maximum, this doe sn’t really matter because you don’t reach it. But if you had over $2000 in dental costs, they would only pay to $2000 and you would be responsible for anything beyond that.

    Definition of info:

    Submitted charges = this is what the dentist charged you

    Considered charge = the dentist and the insurance have an agreement, that when you use this dentist (it that you will get a discount). This amount is the discount. So for the root canal on 12/03, they charged you $220 but because of the discount, they can only charge you $131

    Covered charge = the amount that the insurance has agreed to pay for this procedure for your specific situation (for example: on the composite treatments they pay less because of the resins that were used – see remarks section)

    Coverage Percent = the amount that your insurance has agreed to pay. For wellness (checkups, xrays, etc) your plan pays 100% of the bill. For treatment (fillings, root canals, etc) your plan pays 90%.

    Benefit Amount = dollar amount that the insurance is paying for that line

    You are responsible for paying the:

    - Deductable = $50

    - The difference between the benefit amount & the considered charge

    You can add it up, but mostly likely it is correct and you owe the additional $1325.

    If you didn’t have insurance you would have been required to pay $2772. With insurance you have to pay $1557, so you go about a 44% discount using insurance.

    Dental insurance is usually not that great of insurance (as you are finding out). But teeth are the only bone in your body that don’t grow back, so you need to keep them healthy. Since cleanings look like they are free with your insurance, you need to make sure you get this done.

    I have HORRIBLE teeth (genetics) – a filling on almost every tooth, many many crowns, and even something called a dental implant (it’s a titanium tooth that looks like a regular tooth. I brush but I don’t floss as much as I should. A few years ago, I started getting a cleaning 4 times a year instead of just 2 and since then I haven’t had a single cavity.

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  • 5 years ago

    This Site Might Help You.

    RE:

    Dentist charges a copay and after insurance provider pays less than submitted, charges the rest amount to me?

    I went to a dentist, got some cavity fillings (9) and deep cleaning done.

    They said my co-pay was $232

    After 10 days i receive a letter saying,

    the total amount for service: $2772

    Insurance paid: $1215

    Patient paid: $232.

    Hence they ask me to pay the remaining amount of $1325.

    I...

    Source(s): dentist charges copay insurance provider pays submitted charges rest amount me: https://shortly.im/WaffS
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  • Erika
    Lv 4
    3 years ago

    Dental Copay

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  • 1 decade ago

    You just asked this a few days ago, and got accurate answers.

    You have to call the insurance company to ask them how much YOU are supposed to pay. The dentist could be balance billing you - which is illegal - or he may not be.

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  • 1 decade ago

    This is a repeat question and the answer is the same. But, if you got 9 cavities filled then it seems accurate. Also, dental insurance RARELY has copays.

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  • 3 years ago

    I suggest you to visit this website where onel can compare quotes from the best companies: http://INSURECOMPAREQUOTES.US/index.html?src=5YAwk...

    RE :Dentist charges a copay and after insurance provider pays less than submitted, charges the rest amount to me?

    I went to a dentist, got some cavity fillings (9) and deep cleaning done.

    They said my co-pay was $232

    After 10 days i receive a letter saying,

    the total amount for service: $2772

    Insurance paid: $1215

    Patient paid: $232.

    Hence they ask me to pay the remaining amount of $1325.

    I don't want to pay? What are the options?

    If it was so much, i wouldn't have gone for it

    I have attached the Explanation of Benefits in the below link (totally 3):

    img8. imageshack. us / g / eob1. jpg /

    Update: PS: Having problem in posting a link, hence with spaces...

    Follow 6 answers

    Source(s): I suggest you to visit this website where onel can compare quotes from the best companies: http://INSURECOMPAREQUOTES.US/index.html?src=5YAwk...
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  • 4 years ago

    For the best answers, search on this site https://shorturl.im/avMRu

    The total amount for a few fillings and a cleaning should not be $2772. Please ask this question again and post the dentist's bill in detail, showing how they calculated that amount.

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  • Anonymous
    1 decade ago

    the link does not work. does you dental insurance have a max it will pay? most do, and the majority of the plans i have seen max out at $1,000. I suggest contacting your benefit rep or human resource department to assist you.

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  • Anonymous
    1 decade ago

    You've already asked this before.

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