Question: I went to the dentist and had some work done. The dental office said my dental insurance policy covered the services I needed up to 50 percent, so I paid half the cost of the services rendered at the time. Yet about two weeks later, the dental office tried to charge me more money, saying that the insurance company did not pay the remaining 50 percent and I still had a balance due. 

Reply: You can still have a balance due for many reasons besides a lying dentist. However, the first place to call would be your dental insurance member services line for claims. The claims department could advise you why they did not pay out as you expected. Examples could be: 

• You maxed out your yearly maximal limitation. 
• You had a deductible. 
• You went to a dental office outside the network with UCR fees. 
• You went to a dental office in the network of providers but out of your rating area and had UCR fees.
• You had a higher-cost dental service than what the plan covers, so they covered you at a lower cost. An example would be that the plan covers up to 50 percent of a Resin Crown with high noble metal, but if you have a Full Porcelain Crown that is more costly, the plan covers you at the cost of the Resin Crown.

 If, after speaking to the dental insurance claims department, you still feel like you were misled by the dental office regarding cost and coverage, you would then call the dental office. With that said, most dental offices will say that your cost was an estimate based on your policy, but that final cost is determined by what the company pays out. 

It’s important to note that even when submitting a claim for a quote, only to the insurance company so that you know what the company will pay on the claim before having the services. Even the company will state that it is an estimate and can be subject to change.