In a prior post we had someone stated that they have a $2000.00 maximum limitation but had dental care cost of $2200.00. They paid the dental office $200.00 thinking that should be the only cost for them to pay. Yet was surprised that they received a bill for an additional $400.00. Now there are a few ways this can happen but here are a few listed that could be the likely reason.
1) They forgot about their plans Co-pay: In most plans there are co-pays you need to take into account. Such as the company will pay 50% for major dental care and your co-pay is the other 50% left. Normally the dental insurance plan dose not pay out %100 of your dental care with the exception of preventive services that sometimes will be paid %100 however not always with in the plans first year.
2) They forgot their deductible: Many PPO’s/Indemnity insurance plans have they can normally range from $50.00 – $150.00 per person per calender year.
3) They went over UCR: Most PPO’s/Indemnity insurance plans pay out up to UCR (Usual And Customary Rates) They may have also gone over this UCR cost.
The reason in this cast could have been one or a couple of these factors. Understanding how your dental insurance works, it terms and conditions will help you to avoid these types of unwelcome surprises.