Dentist reached “cap” on patients with my insurance… could I do an independent claim? Called insurance. Still unsure .
I’m 25 and still covered under my parents’ dental insurance. Our current dentist is retiring, so I need to find a new one.
There’s another dentist in town that we really like, but the office said they’ve reached their “personal cap” for patients with my insurance (Delta Dental). They are still accepting self-pay/general patients, just not additional patients through Delta Dental.
My plan includes out-of-network benefits. Am I correct that if I become a general/out-of-network patient, I can submit the claim to Delta Dental myself and receive reimbursement? I know it likely won’t cover 100% of the cost. I’m just trying to understand how it works.
I called Delta Dental, and the representative said they had never heard of a dentist capping the number of patients with a particular insurance plan. However, they said they “think” I should still be able to submit claims for out-of-network reimbursement and to make sure the reimbursement is sent to me, not the dentist.
Has anyone experienced something similar? If so, how did it work out? I’d really appreciate hearing your experience, good or bad, because this whole situation has me pretty anxious.
Unfortunately, the other dentists in our area either aren’t highly recommended or aren’t accepting new patients.