Dental Benefits Question

Discussion in 'UPS Discussions' started by ThatsLogistics, Apr 22, 2014.

  1. ThatsLogistics

    ThatsLogistics New Member

    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?

  2. oldngray

    oldngray nowhere special

    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.
  3. 9.5er

    9.5er Well-Known Member

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

    UpstateNYUPSer Very proud grandfather.

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

    greengrenades To be the man, you gotta beat the man.

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

    Wally Hailing from Parts Unknown.

    Your local union might have some more info.
  7. Dr.Brown

    Dr.Brown Swollen Member

    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)
  8. brown bomber

    brown bomber 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
  9. upschuck

    upschuck Well-Known Member

    Wow, what are you having? a mouth transplant?
  10. HBGPreloader

    HBGPreloader Active Member

    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 :(
  11. bleedinbrown58

    bleedinbrown58 mouth breathers...everywhere

    I agree with 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 only covers 50% and is capped at 2,500 annually.
  12. mike1646

    mike1646 Active Member

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

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  13. oldngray

    oldngray nowhere special

    It used to be better. Welcome to Teamcare?
  14. mike1646

    mike1646 Active Member

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

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  15. Future

    Future Well-Known Member

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

    oldngray nowhere special

    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.
  17. UpstateNYUPSer

    UpstateNYUPSer Very proud grandfather.

    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.