Can a dentist charge beyond what is covered by the insurance?

Updated: Mar 18, 2023

Can a dentist charge beyond what is covered by the insurance?

Dental insurance can be a great way to help cover the costs of routine and necessary dental care. However, many patients are surprised to find out that their insurance does not cover the full cost of their treatment. In some cases, patients may wonder if a dentist can charge beyond what is covered by insurance. The answer is yes, but there are some important things to keep in mind.

Dental insurance plans typically have a limit on the amount of coverage they provide for a given treatment. This limit is known as the "maximum allowable charge" or "MAC." For example, if a dental procedure costs $500, but the MAC for that procedure under your insurance plan is $400, your insurance will only cover $400, and you will be responsible for the remaining $100.

In some cases, dentists may charge more than the MAC set by the insurance company. This is known as balance billing. However, it is important to note that balance billing is not allowed by all insurance plans or in all states. In some states, it is against the law for a dentist to balance bill a patient.

If balance billing is allowed under your insurance plan and in your state, you will be responsible for paying the difference between the amount your insurance will cover and the total cost of the treatment. This means that you may end up paying more for a dental procedure than you anticipated. However, it is important to remember that your dentist is providing a service and is entitled to charge a fair and reasonable fee for their services.

It is also important to note that some dentists may charge more than others for the same procedure. This can be due to a variety of factors, such as the dentist's level of experience, the materials used in the procedure, and the location of the dental practice. It is always a good idea to shop around and compare prices from multiple dentists before committing to a treatment.

If you are concerned about the cost of a particular dental procedure, it is important to talk to your dentist before the treatment begins. Your dentist can provide you with a cost estimate and explain what your insurance will cover. They may also be able to suggest alternative treatments or payment options to help make the procedure more affordable.

In conclusion, dentists can charge beyond what is covered by insurance, but this is not always allowed under all insurance plans or in all states. If you are concerned about the cost of a dental procedure, it is important to talk to your dentist and your insurance company to understand what your options are. By being informed and asking questions, you can make sure you get the care you need at a price you can afford.