Question: I have dental insurance for my family though my job. I took my two year old to the dentist for basic check up and simple cleaning which was supposed to be free. Yet I got a bill for $ 125.36. I do not get why this is the case when preventive services are no charge and my two year old went to one of their pediatric dentist in their network.
Answer: I am unable to address your coverage’s you have under your group policy you have though work. Yet I can provide you with some possible causes.
1) You have a PPO and the plan pays 100% of preventive care up to UCR.. Therefore it is possible you went over the UCR and their for have UCR cost to cover.
2) You have a PPO dental insurance plan and you have a deductible you still have to meet prior to benefits kicking in.
3) Although this may not be the case, you have a PPO plan and you went over your yearly maximum limitation.
4) You have an HMO and the plan dose not cover for specialist (Pediatric dentist are specialist)
5) You have an HMO that offers benefits for plan specialist but at reduce coverages.
Course the only way you can know for sure is by calling your dental insurance member services line and finding out directly. I am sure they will be happy to explain to you your plan benefits and coverages. You may also want to pull the plan policy to go over your plans terms and conditions. It is important to know your plans exclusions and limitation so that you are not surprised by a unwanted bill.