How the heck does dental insurance work?

Question

I called my insurance company buy the lady I talked to sounded really confused. If she's confused, how is that supposed to help me???

I know it varies from plan to plan. Here is what I know so far:

I have a $2500 maximum per calendar year.

I have an "80%/20%" plan (???)

My deductable is $300 (???)

Here is what I don't get:

I went to the dentist, my bill was $306, my insurance paid for all but $28 of it... if my deductable is $300, shouldn't I have to pay $300?

I do not understand the 80/20 thing, if I have a deductable too.

Anyone insurange brokers out there?

Answer 1

You should pay the first $300, and 20% of the remainder.

But with dental, there are some things that are covered, and some that aren't.  Say you got a flouride treatment - that's usually not covere - you'd pay 100% of that.

But usually the cleaning and exam is covered in full, not subject to the deductible.

Answer 2

The way it's supposed to work using your figures - you pay the $300 deductible then 20% of the remaining $6 ($1.20) for a total of $301.20.

Possible explainations (since we don't have the bill to look at or know your history with this plan)

-your deductible is per lifetime and you've already paid in a different year.

-you've already paid part of the deductible previously if the deductible is annual.

-the deductible may be per family instead of per person.

-the insurance company may not have paid the amount to the dentist yet. Your bill is just an estimate of the charges and may change after the insurance company processes it.

-you may be on a DPO or DMO plan and the billed amount is less than the actual charges because the insurance company will only allow reasonable and customary fees.