My dad needs final restoration (consisting of 5 procedure codes/modules) after a root canal theraphy on his molar.... His annual coverage is $1500 and he had used up about $960.... I am expecting that his dental coverage remaining for the year will not pay all of the contract price. The situation is that the remaining coverage will probably cover the contract price of 3 and 1/2 procedures modules.... The insurance company says it's up to the provider to decide what they will charge if you go over the annual limit of $1500, but from their observation, most providers tend to just charge the contract price so that patient ends up paying the contract price and plus the co-insurance instead of the actual non-contract price. Has anyone had experience or opinion with this kind of situation where you expect you will run over the annual coverage limit? Both the patient and provider perspectives are appreciated. Thanks.
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