https://boards.hellobee.com/ Pregnancy, Baby and Parenting blog, by Hellobee en Sun, 19 Apr 2026 00:02:49 +0000 https://boards.hellobee.com/topic/what-criteria-determines-fair-and-reasonable#post-1792021 Thu, 31 Jul 2014 12:50:19 +0000 Mrs. Jump Rope 1792021@https://boards.hellobee.com/ <p>@Mamaof2: I will! I wonder if it's too late? My appt was in May! </p> https://boards.hellobee.com/topic/what-criteria-determines-fair-and-reasonable#post-1792018 Thu, 31 Jul 2014 12:49:38 +0000 Mamaof2 1792018@https://boards.hellobee.com/ <p>@Mrs. Jump Rope: can you ask them for a cash rate? When we 1st moved here DS was sick and I didn't realize the Ped didn't take our insurance - bill was $125 but since I paid cash she only charged me $75 </p> https://boards.hellobee.com/topic/what-criteria-determines-fair-and-reasonable#post-1791994 Thu, 31 Jul 2014 12:42:31 +0000 MsLipGloss 1791994@https://boards.hellobee.com/ <p>@Mrs. Jump Rope: The premiums might not be much, but it's just enough to be an annoyance! (my premium for dental is pretty low too!) </p> https://boards.hellobee.com/topic/what-criteria-determines-fair-and-reasonable#post-1791986 Thu, 31 Jul 2014 12:41:07 +0000 Mrs. Jump Rope 1791986@https://boards.hellobee.com/ <p>@MsLipGloss: holy shit! That's a crazy bill. </p> <p>I think we pay $10/mo for dental. It isn't high.</p> <p>But this is the kick in the butt I needed to find someone in-network! </p> https://boards.hellobee.com/topic/what-criteria-determines-fair-and-reasonable#post-1791941 Thu, 31 Jul 2014 12:32:00 +0000 MsLipGloss 1791941@https://boards.hellobee.com/ <p>@Mrs. Jump Rope: Yeah, and let's not even add in what you pay in premiums every month. *lesigh* </p> https://boards.hellobee.com/topic/what-criteria-determines-fair-and-reasonable#post-1791938 Thu, 31 Jul 2014 12:31:25 +0000 MsLipGloss 1791938@https://boards.hellobee.com/ <p>@Mrs. Jump Rope: I have been in the opposite situation . . . where the charges billed to me as an uninsured patient were significantly higher than what they would have been to an insurance company. I was able to negotiate a discount, although that was only because I was able to pay it all up front (the bill was right around $3k). </p> https://boards.hellobee.com/topic/what-criteria-determines-fair-and-reasonable#post-1791926 Thu, 31 Jul 2014 12:28:18 +0000 Mrs. Jump Rope 1791926@https://boards.hellobee.com/ <p>@MsLipGloss: I didn't, so I knew I had to cough up the $100!</p> <p>When everything was said and done, insurance paid $110 and I have to pay the balance, which is close to $400.</p> <p>It seriously would have been cheaper to not even bill insurance! </p> https://boards.hellobee.com/topic/what-criteria-determines-fair-and-reasonable#post-1791918 Thu, 31 Jul 2014 12:26:09 +0000 Mamaof2 1791918@https://boards.hellobee.com/ <p>not sure how it changes from in network to out of network but when I get bills they are always more than insurance will pay</p> <p>for ex:</p> <p>$100 bill</p> <p>Insurance says billable rate is $75</p> <p>Insurance then pays a % of that, lets say $25 and then I would be responsible for the rest up to the BILLABLE rate (so $50) not the original charge. </p> https://boards.hellobee.com/topic/what-criteria-determines-fair-and-reasonable#post-1791917 Thu, 31 Jul 2014 12:25:23 +0000 hilsy85 1791917@https://boards.hellobee.com/ <p>That sounds normal to me...my out of network dentist was very expensive, so the amount insurance covered was nowhere near close to the whole cost of the procedure. It sucked!</p> <p>In the future I just learned to either go to in network providers or find out how much they charge for procedures before having them done. </p> https://boards.hellobee.com/topic/what-criteria-determines-fair-and-reasonable#post-1791912 Thu, 31 Jul 2014 12:23:27 +0000 MsLipGloss 1791912@https://boards.hellobee.com/ <p>Is this because you haven't met your $100 deductible yet? What is u/c/r (usual, customary, and reasonable) is an issue they need to take up with the provider, not the insured . . . </p> <p>ETA: effin insurance! *shakesfist!!*</p> <p>ETA2: I edited my post after reading through it . . . </p> https://boards.hellobee.com/topic/what-criteria-determines-fair-and-reasonable#post-1791907 Thu, 31 Jul 2014 12:22:30 +0000 Smurfette 1791907@https://boards.hellobee.com/ <p>My insurance only covers what they think is the average price for the area if you go out of network. </p> https://boards.hellobee.com/topic/what-criteria-determines-fair-and-reasonable#post-1791903 Thu, 31 Jul 2014 12:21:58 +0000 sarah.clarisse 1791903@https://boards.hellobee.com/ <p>I've had the same issues with dental insurance. When it comes down to it dentists can charge anything they want and I suppose it's reasonable for insurance to cap it. You might have better luck speaking with the dentist for a discount on the remaining costs you owe directly to them. </p> https://boards.hellobee.com/topic/what-criteria-determines-fair-and-reasonable#post-1791876 Thu, 31 Jul 2014 12:16:35 +0000 Mrs. Jump Rope 1791876@https://boards.hellobee.com/ <p>I've been playing phone tag with my dentist, and my dental insurance company is being a complete PITA.</p> <p>TL;DR -- what criteria determines what is considered 'fair and reasonable' for a procedure before insurance will cover it?</p> <p>Long story:<br /> 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. </p> <p>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.</p> <p>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.</p> <p>For instance, I was charged $182 for a cavity. Insurance said $125 was F&amp;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&amp;R (182-125=$57). So for a $182 cavity, I'm paying $132... which is still *more* than what they consider fair and reasonable!</p> <p>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&amp;R is the contracted rate they have with in-network providers so many miles withinin a radius. </p>