I received the EOB and it says:
Amount Claimed:
900.00
Amount Allowed:
714.00
Deduct Applied:
50.00
Other Ins:
00.00
Patient Resp:
443.00
Amount Paid:
271.00
It also says my dentist is in-network, but they are asking me to bring $629 (900-271) instead of $443. Are they asking me to pay more than I should?
Is my dentist charging me more than he should?
byu/2Maverick inpersonalfinance
Posted by 2Maverick
4 Comments
Amount allowed is what the insurance says the procedure is worth, and it’s been calculated to save the insurance company money. It is completely unrelated to what the dentist actually charges or what the procedure truly “should” cost. And every dentist is going to charge a different amount. This is why dentists and patients hate dental insurance.
What is the difference between the amount claimed and the amount allowed? Was it particular line items disallowed, or a lower amount on each line item?
Is the dentist in nework or out of network?
Yes, it looks wrong if they are in-network, you should owe about $443 not $629. Call your insurance and ask the dentist to explain before paying.
Normally if a practice is in network, their contractual agreement with the insurance company is that they accept the “allowed” amount as full payment. Your payment responsibility vs. what the insurance is paying seems off too. Policies often require co-pays or co-insurance where they pay some percentage and you pay the rest, but usually it’s more like they pay 75 or 80% and you pay the balance.
You either need to see what the policy says about your coverages or call the insurance company to see how they came up with these numbers. You should also ask them if it is allowed for the practice to charge more than the allowed amount.