Dental Benefits Question

[ThatsLogistics]

Hi I need help regarding insurance coverage for dental work. I go to a dentist that bills you upfront and then the insurance company sends you the check later on. I'm really confused about how much is covered and how much I am supposed to receive. The bottom 3 in the pic were from a different dentist that didn't make me pay upfront and just billed the insurance company. I paid $0 for the bottom listing and $170 for the next 2 from the bottom. As far as the rest go I have only received one check for the amount around $900. Does anybody have any clue about whether or not this looks correct?

 

[oldngray]

It depends on the details of the plan you are in that varies, and what dental work was done. Cleanings (twice a year) should be 100% covered and 80% of the rest. You may have a yearly cap of $1500 but that varies I think. The amounts you were billed look to be pretty much in normal ranges to me though.

 

[9.5er]

I'd see a different dentist. Find one the files your insurance so you don't have to pay up front.

 

[UpstateNYUPSer(Ret)]

I'd see a different dentist. Find one the files your insurance so you don't have to pay up front.

Better yet, find one who does the above and accepts your insurance as payment in full.

 

[greengrenades]

I'd see a different dentist. Find one the files your insurance so you don't have to pay up front.

I agree, it just seems so much easier, why would anyone not want to do it this way.

 

[Wally]

Your local union might have some more info.

 

[wayfair]

pfft, we only get $1500 a year here... I'd have to get carecredit with the work you had done.....(brush and floss, it takes care of a lot of problems)

 

[brown bomber]

just as the above poster indicated, you might have exceeded your dental maximum
mine prior to retirement was 1500/year. Now that I'm retired it's zilch

 

[upschuck]

Wow, what are you having? a mouth transplant?

 

[HBGPreloader]

As others have mentioned, it depends on your dental plan and whether or not your dentist is a participating provider.

The plan is the insurance and provider is the dentist.

Looking at the picture and generally speaking, the "claim amount" is what your provider charges anyone who walks in off the street.

A participating provider already has an agreement with the plan to charge a certain "flat rate" for covered procedures.

The amount "paid by plan" is generally this "flat rate" negotiated rate that the plan has agreed to pay their providers - whether they negotiated it or not.

The amount "you may pay" is the difference between the two that your provider may or may not bill you for.

My dentist is not a participating provider with my current plan. However, my plan will (generally) pay for 50% of the bill (at the negotiated rate) and I pay the balance. It it capped at $2,500 per year.

From what I've read so far, the new dental plan does not cover anything if you don't use one of their providers. So, it will essentially be useless to me because the participating providers in this area all seem to be fly-by-night operations (located in strip malls) with doctors whose names I can not pronounce. And the couple in the immediate area got bad reviews too

 

[bleedinbrown58]

I agree with 9.5er...you need to find a dentist in your network. I know under my plan, any major dental work is covered 80% in network and is unlimited. Out of network...it only covers 50% and is capped at 2,500 annually.

 

[mike1646]

We need a better plan, $1500 a year doesn't cover much.


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[oldngray]

It used to be better. Welcome to Teamcare?

 

[mike1646]

It's been like that since I started working here 19 years ago


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[Future]

Wow, what are you having? a mouth transplant?

I think the OP has sucked a little to much MGT caulk and lost some teeth in the process.......OUCH!!

 

[oldngray]

My next cleaning is in mid June. I wonder how quickly the new Teamcare insurance will pay the dentist. My local had really really bad insurance set up through the local several years ago that made a lot of promises of saving money but didn't pay many claims and when we got rid of it it took 2 years to pay off the deficit that insurance created when it promised a surplus. We have had good insurance since then but went through a very bad period until we got a good plan.

 

[UpstateNYUPSer(Ret)]

We have RBS/EMSCO for our dental coverage-----they pay promptly and we have excellent coverage. My dentist is a participating provider so I have zero out of pocket, even for crowns.