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I have 100% coverage up to $1000 for Basic, Preventive, Endo & Perio. Does this mean if I go over $1000 max/ yr, I am paying out of pocket? I have already had a root canal and still need a cleaning, crown and a filling.
Keep in mind, the insurance coverage is most likely saying it will pay up to $1,000 on agreed upon charges. In other words, if you have a cleaning done and the dentist charges $215, the insurance may pay out only $150 (because they say that is the customary charge) you may have to pay the additional $65 for the cleaning. The insurance company will subtract the $150 for the $1000 leaving you will $850 to cover additional work. But they will continue to pay less than the full price of the work. Some dentists will not bill you for the remainder and some do. You should check will your dentist first and ask for a pretreatment estimate to know what to expect regarding out of pocket expenses. Bottom line I don't think 100% of a $1,000 really mean just that.
http://www.yourdentistryguide.com/insurance/
It is important to ask the dentist’s finance manager about dental treatment costs prior to agreeing to and receiving treatment. Dental insurance plans differ in the level of reimbursement offered for certain procedures and in annual dental spending caps. Some plans limit the waiting period before certain dental treatments are rendered. Additionally, plans typically have exclusions, meaning that costs for certain dental procedures will not be reimbursed. Dental finance managers can call your insurance provider to pre-determine the out-of-pocket costs associated with your planned procedure.
Usual, Customary, and Reasonable (UCR) Fees
The most common term used by dental insurance companies on their Explanation of Benefits (EOB) statement to identify the fee for dental treatment is called Usual, Customary and Reasonable (UCR). UCR fees are determined by insurance providers based on the typical costs associated with various dental procedures.
For example, if your procedure costs $90, your dental insurance provider may have a UCR for the procedure of $60. You would therefore be responsible for paying the $30 difference as an out-of-pocket expense.
