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A Dentist’s or dental practice’s failure to comply with the current ADA coding convention, including but not limited to upcoding, the overutilization of certain codes, and/or the misrepresentation of services (e.g., unbundling).
09/17/2018 03:44 PM EDT If you are on a policy that requires you to go to a participating provider, you should not be charged the difference between these two prices. A contracted dentist generally has an agreement with the insurance company to write off the difference in charges. If the policy allows you to go to a dentist or pediatric dentist of your choice, check the insurance company’s UCR fee guide against the fees that dentist charges. You may be required to pay the difference out of your pocket, however, you cannot put a price tag on quality dental care.
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Hospitals MEMBER SERVICES If your selected participating dentist determines that you need specialty care, you have access to a network of specialty care providers. Most plans are Direct Referral plans, which means your selected participating dentist will provide you with the name of a network specialist. No pre-authorization is required – you can call the specialist directly to schedule your visit.2
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