Author Topic: Please explain dental EOB  (Read 158 times)

carefornelly

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Please explain dental EOB
« on: August 21, 2017, 10:13:37 AM »
My son had 2 fillings done in his teeth. Cigna calculated our copay to be $251. The problem is that I set up my FSA to make automatic payments of copay/coinsurance to the providers, so they send $251 to our dentist.

The doctor is in network.

Now, looking at the EOB, I think that we should've paid $256 - $164.60 = $91.20. Am I right? Do the alternative provisions mean that the original charges are not valid (2 charges $208 each) ?

Thank you



Service                     Billed        Contracted Covered  Deductbl   Remaining Cigna    You         Notes
                                amt           amt             amt                         balance     paid        owe
----------------------------------------------------------------------------------------------------------------------------
Filling, 2 surfaces    $208.00    $208.00       $0.00          $0.00   $208.00    $0.00    $0.00    AA
Filling, 2 surfaces    $0.00    $128.00      $128.00    $50.00     $65.60   $62.40    $145.60    AB
Filling, 2 surfaces    $208.00    $208.00       $0.00          $0.00   $208.00     $0.00    $0.00    AC
Filling, 2 surfaces    $0.00    $128.00       $128.00      $0.00     $25.60   $102.40 $105.60    AD

NOTES
AA   Under the provision of your Dental plan, an alternate benefit allowance has been applied. Please see your plan booklet for further explanation of this provision.
AB   This is the benefit allowance under the alternate benefit provision of your plan.
AC   Under the provision of your Dental plan, an alternate benefit allowance has been applied. Please see your plan booklet for further explanation of this provision.
AD   This is the benefit allowance under the alternate benefit provision of your plan.

Michele

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Re: Please explain dental EOB
« Reply #1 on: August 21, 2017, 12:20:44 PM »
I would contact CIGNA for clarification.  They are indicating the allowed amount is the full billed amount of $208, but then they indicate the contracted rate is $128.  But under the column "You Owe" it shows the $251.  I personally would want CIGNA to explain to me why they show you owe up tot he $208 per filling if the Contracted Amount is $128.
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