I just relocated to the U.S. and need some clarity regarding my dental insurance situation with Delta Dental PPO for Invisalign. According to Delta Dental, I should receive a $2,000 discount for going with an in-network provider.
I’ve gone to an in-network dentist who gave me a quote for:
- Total cost: $5,500
- Insurance coverage: $1,800
- Out-of-pocket expense: $3,700
I reached out to Delta Dental, and they informed me that I should get an in-network discount, bringing my out-of-pocket cost down to a maximum of $1,700.
If I get my pre-estimate back and it indicates that the accepted fee is only $3,500, will I then only be responsible for paying $1,700?
It sounds like you’re in a bit of a confusing situation with your dental insurance and Invisalign treatment. Based on what you’ve described, here’s a breakdown of the points to consider:
Understanding the Quote: The total quoted by the in-network doctor is $5,500, and your insurance is expected to cover $1,800. That would leave you with an out-of-pocket cost of $3,700.
In-Network Discount: If Delta Dental indicates that you’re entitled to an in-network discount, and they believe your out-of-pocket cost should only be $1,700, it’s possible that the actual negotiated fee for the service is lower than the quoted price.
Pre-Estimate Submission: When you get the pre-estimate back showing an accepted fee of $3,500, that means that this is the amount Delta Dental has agreed to cover for the treatment with the specific provider.
Final Payment Calculation:
Yes, if the pre-estimate confirms the accepted fee at $3,500, then your out-of-pocket cost should be $1,700, assuming other variables or conditions don’t come into play.
It’s always good to clarify directly with Delta Dental if you have any further questions or uncertainties regarding the coverage and adjustments.