When paying for dental services (fillings), if the patient share is $28 and there are two fillings, should the total OOP cost be $56 or $125 (the patient share plus $75 deductible)? Thank you for any clarification you can provide.
Good afternoon! Great question, I would be happy to clarify.
According to your specific benefit plan, a filling would be classified as a basic service. This means, it would be payable at an 80% coinsurance level versus the 50% that you were thinking. This, if course would begin once your $75 deductible is met.
As an example - say the filling cost is $180. You would pay $75, plus 20% which would total $96. ($180 - $75 = $105. 20% of $105 =$21. $75+$21=$96)
This would apply to those services performed in network. Check out this link to find out more on how to locate an in network provider.
What providers are in my network?
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