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BC/BS PMD Dentist Question #934940
04/15/14 03:13 PM
04/15/14 03:13 PM
Joined: Mar 2008
Posts: 25,905
Prattville, Alabama
Skullworks Online content OP
Freak of Nature
Skullworks  Online Content OP
Freak of Nature
Joined: Mar 2008
Posts: 25,905
Prattville, Alabama
Say you go to a BC/BS PMD dentist and he charges $800 for a procedure. BC/BS sends your statement and says the average/allowable charge for that is $600 and BC/BS pays $450 then are you liable for the remaining $150 of the average/allowable charge or for the remaining $350 of the total charge?

Last edited by Skullworks; 04/15/14 03:13 PM.

"I'm not near as critical about how big they are as I once was. Smiles are more important now! We will grow more deer."
Jimmy G.
Re: BC/BS PMD Dentist Question [Re: Skullworks] #934944
04/15/14 03:14 PM
04/15/14 03:14 PM
Joined: Feb 2009
Posts: 14,831
If you only knew.....
Tru-Talker Offline
Booner
Tru-Talker  Offline
Booner
Joined: Feb 2009
Posts: 14,831
If you only knew.....
$150


Before you embark on a journey of revenge, dig two graves...

Confucius
Re: BC/BS PMD Dentist Question [Re: Tru-Talker] #934946
04/15/14 03:14 PM
04/15/14 03:14 PM
Joined: Mar 2008
Posts: 25,905
Prattville, Alabama
Skullworks Online content OP
Freak of Nature
Skullworks  Online Content OP
Freak of Nature
Joined: Mar 2008
Posts: 25,905
Prattville, Alabama
Originally Posted By: Tru-Talker
$150


Okay. That is what I thought.


"I'm not near as critical about how big they are as I once was. Smiles are more important now! We will grow more deer."
Jimmy G.
Re: BC/BS PMD Dentist Question [Re: Skullworks] #935075
04/15/14 04:19 PM
04/15/14 04:19 PM
Joined: Oct 2005
Posts: 3,093
McCalla, AL
johnnyreb Offline
10 point
johnnyreb  Offline
10 point
Joined: Oct 2005
Posts: 3,093
McCalla, AL
It will say on the EOB from blue cross what you owe the dentist. In this case the $150. To get to be a PMD provider, they have to agree to accept assignment, which means they take the blue cross allowable charge and write off the difference.


"We sleep safe in our beds because rough men stand ready in the night to visit violence on those who would do us harm."

George Orwell
Re: BC/BS PMD Dentist Question [Re: Skullworks] #935242
04/16/14 02:29 AM
04/16/14 02:29 AM
Joined: Jan 2013
Posts: 19,619
Pelham
Ben2 Offline
Old Mossy Horns
Ben2  Offline
Old Mossy Horns
Joined: Jan 2013
Posts: 19,619
Pelham
My dental copay doubled with Obama care while the premium tripled. I love Obama care. May be cheaper for some but that some ain't me. Sorry for hijacking, took kids to the dentist today and it cost me $100, used to be $50

Last edited by Ben2; 04/16/14 02:30 AM.
Re: BC/BS PMD Dentist Question [Re: Skullworks] #935319
04/16/14 04:07 AM
04/16/14 04:07 AM
Joined: Dec 2009
Posts: 9,515
Trussville
T
toothdoc Offline
14 point
toothdoc  Offline
14 point
T
Joined: Dec 2009
Posts: 9,515
Trussville
It's not that cut and dry. If you have a deductible (say $50) that comes off the top, so in this scenario, you owe $200. Your co-pay is $150 and you have a $50 deductible. What we are running into with a lot of the newer plans this year is a very high deductible. If you have a $200 deductible, you can add that to the $150. Regardless of how much you pay, the dentist is getting $600, the difference is how bad your insurance is screwing you over.

Re: BC/BS PMD Dentist Question [Re: Skullworks] #935392
04/16/14 05:46 AM
04/16/14 05:46 AM
Joined: Jun 2013
Posts: 5,648
Lincoln, Alabama
B
blumsden Offline
12 point
blumsden  Offline
12 point
B
Joined: Jun 2013
Posts: 5,648
Lincoln, Alabama
It will say on your EOB, what your cost is. $150, plus any deductible.

Re: BC/BS PMD Dentist Question [Re: blumsden] #935401
04/16/14 05:52 AM
04/16/14 05:52 AM
Joined: Dec 2011
Posts: 399
M
millstoneman Offline
4 point
millstoneman  Offline
4 point
M
Joined: Dec 2011
Posts: 399
Im not a supporter of ObamaCare but I also can't stand big insurance companies!! Obama Care mandates everyone have health insurance but it does not force insurance companies to provide quality health care. These insurance companies, mainly BC/BS of Alabama are laughing their asses off to the bank. They have put the screws to us all!! They will claim that premiums went up because of the regulations but yada yada yada. Things will not change in this state until their is more competition in the insurance market and people are allowed to sue these big insurances like BC/BS, because they are the ones benefitting the greatest!!

Re: BC/BS PMD Dentist Question [Re: Skullworks] #935408
04/16/14 06:03 AM
04/16/14 06:03 AM
Joined: Oct 2005
Posts: 3,093
McCalla, AL
johnnyreb Offline
10 point
johnnyreb  Offline
10 point
Joined: Oct 2005
Posts: 3,093
McCalla, AL
Deductibles are listed in a separate column on the EOBs sent to policy holders. If there is an amount in that column. You owe that In Addition To the amount in the copay/coinsurance column.


"We sleep safe in our beds because rough men stand ready in the night to visit violence on those who would do us harm."

George Orwell
Re: BC/BS PMD Dentist Question [Re: toothdoc] #935411
04/16/14 06:07 AM
04/16/14 06:07 AM
Joined: Dec 2002
Posts: 3,077
Guntersville, AL
B
BirminghamBuck Offline
10 point
BirminghamBuck  Offline
10 point
B
Joined: Dec 2002
Posts: 3,077
Guntersville, AL
Originally Posted By: toothdoc
It's not that cut and dry. If you have a deductible (say $50) that comes off the top, so in this scenario, you owe $200. Your co-pay is $150 and you have a $50 deductible. What we are running into with a lot of the newer plans this year is a very high deductible. If you have a $200 deductible, you can add that to the $150. Regardless of how much you pay, the dentist is getting $600, the difference is how bad your insurance is screwing you over.


I disagree, the deductible is not added onto the out-of-pocket. The deductible is included in the out of pocket. If you haven't met your deductible, you will be paying that amount if the allowable charges are over it plus the copay.

For instance, let's say you have a $100 deductible and you get a filling. The dentist's allowable charges (just for example)are $150. Your insurance states that they pay 80% with a $100 deductible and $25 copay. For your visit, you will be responsible for $125 while insurance will cover $25. Now, if you get another filling in the same year, then since you have met your deductible you will be responsible for 20% (what insurance doesn't pay plus the copay) - which would be $55 ($30 + $25) while insurance covers $95.

Yes, the dentist will still get the $600 if that is the allowable charges for the service according to the provider contract, it has just shifted since Obamacare that people pay more up front - and out of pocket for that matter.

Edited because i left out copay.

Last edited by BirminghamBuck; 04/16/14 06:26 AM.

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