Non-covered services rule

Definition

A state law saying a dental plan may not set your fee for treatment the plan does not pay for.

Why It Matters

The expensive half is the definition of a covered service. A patient who burned the annual maximum in March is still receiving covered treatment for the rest of the year, so the plan's discounted fee still binds. The cash-pay upside a seller shows on a PPO book is smaller than the schedule implies. What the law frees is the genuinely uncovered work, much cosmetic and adult orthodontic treatment among it, which is where a repricing plan has room. Ask whether the practice's state carries such a law at all, and split the schedule into uncovered work and work that is merely capped, before you agree a price.