I've been playing phone tag with my dentist, and my dental insurance company is being a complete PITA.

TL;DR -- what criteria determines what is considered 'fair and reasonable' for a procedure before insurance will cover it?

Long story:
I purposefully went to my out of network dentist for a routine cleaning and learned I had two cavities, which I had filled two days later. I've been meaning to find someone closer and in-network but haven't, and the cavities was a pressing issue.

My out-of-network coverage has a $100 deductible and then all procedures are covered at 60%. My bill came in at close to $400, *with* insurance coverage. Without insurance, the bill was a little over $400.

Naturally, I called my insurance to get the scoop. They said my dentists fees are not "fair and reasonable", so they pay 60% of what they consider reasonable. I'm then responsible for 100% of the difference.

For instance, I was charged $182 for a cavity. Insurance said $125 was F&R, so they paid 60% of that ($75) then I am responsible for the difference ($50) plus the difference for the original charge and the F&R (182-125=$57). So for a $182 cavity, I'm paying $132... which is still *more* than what they consider fair and reasonable!

Does this sound normal to you? If it doesn't, are there any questions I should be asking if I call again? I'm guessing F&R is the contracted rate they have with in-network providers so many miles withinin a radius.