arbatistoni

So i'm going off experience here, because i somehow locked myself out of the met-life benefits page. But i worked in dental insurance and heres how it usually works. Call them if you are unsure.

When you "go in network", the providers that participate in the network agree to a pre-set schedule of fees, that is in their contract. they can request whatever fee they want but met-life will tell them they are only allowed to bill a certain amount after the claim is processed. So then your copay percentages and deductibles are paid based on those fees. For example:

The in-network dentist does a cleaning and a routine exam. They want to charge $200 for each. They send a claim to met-life. Met-life says, you are in our network so you can only charge $50 for the exam and $75 for the cleaning. And Those are preventive services so we cover 100%. and the deductible doesn't apply to preventive services. They cut the dentist a check for $125 and you end up paying nothing. If you go out of network, the way it normally works is they pay whatever they would have paid, except the dentist doesn't have to follow their fee schedule. So they still pay $125 but you now owe $375 which is the difference between billed and covered amount.