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. Forty-four states carry such a law and six do not: South Carolina, Delaware, New York, Michigan, Massachusetts and Hawaii. Ask which side the practice sits on, then split the schedule into uncovered work and work that is merely capped before you agree a price.