I had three fillings done a couple of months ago. At the time, I paid $315, which was the estimated cost. Now, I’ve received a bill for an additional $515. Here’s how the statement looks (rounded numbers):
Total charge: $1000
Total allowed: $260
Insurance paid: $170
I paid: $315
Remaining due: $515
I called my insurance, and they explained that they downgraded the coverage from resin fillings (covered at 80%) to amalgam fillings. My dentist is in-network, my deductible is met, and I haven’t hit my yearly limit. Shouldn’t my insurance still cover 80% of the procedure? Why am I now responsible for this extra $515 after the claim was processed?
Check your Explanation of Benefits (EOB). Does it state that you owe $830? If it does, you’re probably responsible for the amount. Without the EOB, it’s hard to know for sure.
Aeron said:
Check your Explanation of Benefits (EOB). Does it state that you owe $830? If it does, you’re probably responsible for the amount. Without the EOB, it’s hard to know for sure.
I haven’t received an EOB, which makes this even more confusing. The claim on my insurance app shows the same breakdown, with me owing $830 and insurance paying $170.
@Luca
If the claim shows you owe $830, then unfortunately you’re on the hook for that amount. I’d recommend calling your insurance company to clarify why they didn’t cover more. Without seeing the full claim, it’s hard to suggest anything else.
@Luca
Who is your dental insurance through? If it’s MetLife or Delta Dental, you should be able to download your EOB from their website. That should give you a clearer picture of what’s going on.