What happens when I reach my maximum coverage for the year?
After you reach your maximum, whether it is a calendar or plan year, you are responsible for the cost of dental procedures yourself. At Advanced Dentistry by Design, we will bill your insurance company so you will receive your PPO (preferred provider discount), if applicable. Offices that do not bill are participating in what is called “Balance Billing.” Balance billing is when the patient is billed for the “discount” from the insurance company.
If the dentist’s office submitted the charges to the insurance company, and the insurance company did not apply the discount, then the patient is responsible. The problem is between the patient and the insurance, not the doctor. However, if the insurance company did apply the discount and the dental office billed for the total amount, then the error needs to be brought to the attention of the dental office.
It is very important that you review your Explanation of Benefits (EOB), which you will receive prior to your dental office receiving their copy. It is imperative that you are aware of your plan benefits.