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?

$150

Okay. That is what I thought.

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.

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

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.

It will say on your EOB, what your cost is. $150, plus any deductible.

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!!

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.

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.