Just trying to wrap my head around my dental insurance and see if anyone can explain it a bit better. I have Delta Dental insurance as a federal employee. I go to an office and selected my dental insurance based on the Delta Dental website listing over half of the dentists at the office as being inside their PPO network. My husband has had no problems with seeing dentists that are PPO and his basic cleanings and exams are being covered 100%.
Despite having requested that I only be seen by dentists that are PPO, the office keeps having me be seen by dentists that are not (it’s a large multi-dentist practice, I don’t really get to choose which dentist pops in to glance at my mouth and say “looks good” and walks out). My last visit, I was seen by a dentist that WAS listed as PPO by my insurance, and she recommended a filing. They were able to get the filling done that day with another dentist, who apparently is not PPO. On my EOB, the entire visit was filed under the dentist who did the filling, including the cleaning, bitewings and exam that the PPO dentist performed.
I asked the dentist office if the general exam could be billed under the dentist that actually performed it and they said they can only file under one dentist per visit, and they could not resubmit under the dentist that performed it. The office also said that NONE of their dentists are PPO for my insurance, and that I have been told this (which I have not).
My questions are: is it true that only one provider can be billed per visit? Even if two completely different dentist provided services? Secondly, has anyone had a dentist deny being PPO with insurance, when insurance tells me they are PPO? Is one party lying?
As I said above, I have had absolutely no issues with my husbands visits to the practice, and we are covered under the same policy.
submitted by /u/KGB07
[link] [comments]Just trying to wrap my head around my dental insurance and see if anyone can explain it a bit better. I have Delta Dental insurance as a federal employee. I go to an office and selected my dental insurance based on the Delta Dental website listing over half of the dentists at the office as being inside their PPO network. My husband has had no problems with seeing dentists that are PPO and his basic cleanings and exams are being covered 100%. Despite having requested that I only be seen by dentists that are PPO, the office keeps having me be seen by dentists that are not (it’s a large multi-dentist practice, I don’t really get to choose which dentist pops in to glance at my mouth and say “looks good” and walks out). My last visit, I was seen by a dentist that WAS listed as PPO by my insurance, and she recommended a filing. They were able to get the filling done that day with another dentist, who apparently is not PPO. On my EOB, the entire visit was filed under the dentist who did the filling, including the cleaning, bitewings and exam that the PPO dentist performed. I asked the dentist office if the general exam could be billed under the dentist that actually performed it and they said they can only file under one dentist per visit, and they could not resubmit under the dentist that performed it. The office also said that NONE of their dentists are PPO for my insurance, and that I have been told this (which I have not). My questions are: is it true that only one provider can be billed per visit? Even if two completely different dentist provided services? Secondly, has anyone had a dentist deny being PPO with insurance, when insurance tells me they are PPO? Is one party lying? As I said above, I have had absolutely no issues with my husbands visits to the practice, and we are covered under the same policy. submitted by /u/KGB07 [link] [comments]Read Morer/HealthInsurance