UHC The Villages Medicare Advantage FL-004P (HMO-POS) $5000 Dental Benefit
 

According to the United document there is a $0 copay for preventive and comprehensive services like cleaning, fillings and crowns. However, I received an authorization from United that shows this for a dental crown:
Amount Claimed $1504
Amount Allowed $532
Patient Responsible $972
Amount Paid $532

I spoke with United today and am calling the dentist next. Looks like I need to pay $972.

What type of procedure was it?

I was "surprised" when I first moved here and found out that dental benefits aren't as clear as they appear to me. Now, I always get a pre-authorization before I do any dental work.

I had a crown put in a couple of years ago. I don't think the dentist did a good job as it fell off twice in the first year. (I have crown that was put in about 15 years ago and it has never fallen off.)

I went back to the dentist that put the crown in and he glued it back on for free both times. However, when it fell off a third time, I thought this might not be the best dentist so I went to another dentist who was out of network. I told him that I thought the first dentist had not done a great job so I asked about putting in a new crown instead of jus gluing the old one back on. He put it in to the insurance company and they told him that there was no coverage for putting in a second crown. I have to wait five years to put a crown in on the same tooth.

I called the insurance company and told them that I thought that their in-network doctor had not done a proper job and that I should be entitled to a new crown. She told me that no matter had bad the first crown was put on, they will not authorize a new crown until five years have gone by. I have UHC Advantage.

Yeah, UHC works until it doesn't. .
Looks like you have a different expectation/interpretation of co-pay than UHC. .
which is how they advertise, but not how they operate. .

This is for a dental crown.

You might find that as part of the Dentists agreement with UHC that the Dentist has contracted to do this work at the contracted price ie...$532.00

I know that each crown is different but I had one put on less than a year ago and it was $940.00 I did not have insurance. I now have insurance and it pays 30% of the covered charges for a crown. My guess would be if I need another one it will be about 30% higher than last year.

Correct. But seems like I am responsible for $972. I find it hard to believe that the dentist is going to accept only $532 for the crown.

I have the same plan. The website says under plan benefits:


You pay a $0 copay for all other covered comprehensive services, including crowns, fillings, root canals, extractions, general anesthesia, IV sedation, occlusal guards and modifications and adjustments to dentures and bridges from network providers

Network dentists have agreed to provide services at a negotiated rate.

I am not an insurance expert but it seems like there is no copay.

When I had the crown in 2023, the dentist billed $1378.00 and UHC paid $753. There was no coinsurance, copay, or deductible.

What did UHC say when you called?

I figured it out. The dentist needs to resubmit the estimate they coded something wrong. In network should pay 100% for the crown.

No wonder patients find billing confusing. The doctors can’t even figure it out!

Keep adding freebies to a dead horse (MA plan), it’s still a dead horse. Think about it the common sense way: the insurance company issuing the advantage plan has to make money, thousands of $$$ off of you, what are they not going to give you? Medical service for 1, they will keep denying you service until 67% of their clients roll over accept their denial of service. Don’t believe me, call them and ask them if they can deny you medical service, and then Google advantage plans being looked at in congress for shady practices

I believe your dentist may not be in-network with UHC which is the reason for the additional charge.

Out of network?

His cost is less than $100 plus time plus overhead.

That’s true with most dental insurance, not just UHC