Out-of-network dentists frequently charge you and your insurance through a process known as balance billing.
In this case, balance billing means the difference between the submitted fee and the allowed amount.
The submitted amount versus what your plan accepts is often enormous, sometimes twice as high.
When dentists overcharge on the contracted amount, loopholes in fee capping laws make it possible to dispute the higher bills.
Dentists can sometimes charge more than insurance allows.
Other times, they must adhere to the contract amount stated in the Explanation of Benefits (EOB).
Investigating which state your PPO or EPO dental plan was issued in is the second thing to do if your dentist overcharged you relative to what insurance allows.
Fee-capping laws apply only to plans sold in the state.
The rule interpretations vary based on whether you have individual or group coverage.
The American Dental Association’s (ADA) Tip Sheet on Dental Board Complaints provides information about who can file complaints against a dentist with the dental board, what to do if you are named in a complaint, and possible outcomes of dental board complaints.
