我有两个dental PPO 保险 Cigna (primary) and Delta Dental (secondary).
Both insurance plans have a $50 deductible and cover 80% of the fee for fillings. Here are the details of the claim:
Cigna’s contract fee: $213
- Cigna paid $130.40
- Patient responsibility: $82.60
- Calculation: ($213 - $50) * 0.8 = $130.40
Delta Dental’s contract fee: $340
- Delta Dental paid $82.60, covering up to 100% of Cigna’s contract fee
- Delta Dental’s EOB states that the patient’s responsibility is $127
- Calculation: $340 - $213 = $127 (difference between the two companies’ contract fees)
现在牙医让我付127 based on Delta Dental’s EOB. 拒绝之后, 又让我付$50 deductible. 我付了.
现在牙医已经收到了$263, 超过了cigna contract fee of $213.
- $130.40 from Cigna
- $82.60 from Delta Dental
- $50 from me (the patient)
我觉得我不需要付任何钱, 包括这个50 deductible, 因为牙医已经收到full payment of my primary insurance contract fee. 如果我没有第二个保险, 这就是牙医全部的收入.
大家有相关经验吗? 该怎么搞?