Billed vs Allowed

[madasheck]

I have had some major dental work done recently at a provider that is preferred by my insurance.

The dentist billed my insurance $3000.00. The insurance company allowed $2000.00 for this work and paid $1000 on the bill.

What is the amount I now owe the dentist. Do I have to pay the difference of the billed amount and what the insurance paid or do I pay the difference between the allowed amount and what the insurance paid.

[Msradar]

There are factors that will determine what you pay. Did you go to a dentist in your plan? Is that a dentist that accepts assignment by your plan. If the answer is yes. Then you pay you portion from the allowable charges. Most people have a deductible or co-pay for major dental work.

I would also look at the EOB(explaination of benefits) you got from your dental provider. If its say the allowable amount and then patient is responsible for $xx...that is what you pay.

Since you said they charged $3000, insurance company allowed $2000 and paid the dentist $1000...sounds like you have 50% plan...which would make you owe the other $1000.

[THEMEANOGRE]

I'm sorry, MsRadar, Your math doesn't work. The total bill came to $3000. The allowable was $2000. The insurance company paid $1000. Where does the 50/50 come from?

[siamcat]

Some providers have an agreement that they take the amount that the insurance deems right for a certain service and you pay your share/co-pay. If they didn't sign that agreement you owe the balance the insurance didn't pay.

[stormy]

Madasheck did say the dentist was a preferred provider, which would mean they accept the insurance company's allowable charge. They charge $3000, allowable was only $2000, and the insurance paid $1,000, leaving you with the remaining $1,000 to pay as your co-pay, which in turn would be 50% co-pay.

The dentist can charge $50,000, but if they are a preferred provider, they must accept the insurance company's allowable charge for the procedure. You pay 50% of that allowable charge.