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View Full Version : MetLife Dental Enhanced


ParkingatMIA
02-09-2019, 09:42 AM
I was trying to look up information between in network and out of network dentists. Are the rates all the same or do we get benefits/discounts going in network?

* also let me know if you have any recommendations for denstists in Miami


arbatistoni
02-09-2019, 10:07 AM
I was trying to look up information between in network and out of network dentists. Are the rates all the same or do we get benefits/discounts going in network?

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.

3GreenKSNA
02-09-2019, 11:13 AM
I had a major problem with an unscrupulous provider so be very careful. When asked if they took our insurance they said yes. What I failed to ask is if they were in or out of network. They ended up being out of network. Found this out the hard way later on.

If they had been in network I would have paid a lot less, Regardless of their shady actions I describe below. They had no intention of filing a claim for the cavity filings despite their paperwork saying they were being paid out from the insurance. When I called met life they explained they had only received a claim for the preventive work. The office presented me with a document showing my portion and the insurance companies portion. My portion alone was more than what the total amount authorized by MetLife. The dentist was perfectly happy over charging me even as an out of network provider keeping my money and not filing a claim with MetLife as their total income would have been vastly reduced. The dentist office hoped I would not have done my homework. I ended up getting my money back.

MetLife was great, franchised dental office, not so much.

-Keep the dirty side down


arbatistoni
02-09-2019, 08:52 PM
I had a major problem with an unscrupulous provider so be very careful. When asked if they took our insurance they said yes. What I failed to ask is if they were in or out of network. They ended up being out of network. Found this out the hard way later on.

If they had been in network I would have paid a lot less, Regardless of their shady actions I describe below. They had no intention of filing a claim for the cavity filings despite their paperwork saying they were being paid out from the insurance. When I called met life they explained they had only received a claim for the preventive work. The office presented me with a document showing my portion and the insurance companies portion. My portion alone was more than what the total amount authorized by MetLife. The dentist was perfectly happy over charging me even as an out of network provider keeping my money and not filing a claim with MetLife as their total income would have been vastly reduced. The dentist office hoped I would not have done my homework. I ended up getting my money back.

MetLife was great, franchised dental office, not so much.

-Keep the dirty side down


yes, unfortunately, this is legal in almost all states.

Ensuring the doctor is in network is the patient's responsibility. Keep in mind that a doctor can be in network at one office and out of network at another.

Also the doctor doesn't have to submit a claim. nearly all reputable dentist offices will, but they don't "have to". they can force it on you.

if you are having any work done that may be expensive, or you need to be certain that it will be covered beforehand, have the dentist office submit a "predetermination" its basically a sample claim they submit to see how it gets covered, before you do the work. the two drawbacks is you probably need to get an exam, and xrays done before they can even submit a predetermination so they know what kind of work they will be doing, plus predeterminations usually take a while to process. up to 6 weeks at certain insurance companies.