u/foggysf

Newbie here. If a pt with insurance plan that only covers preventative services, but now needs a crown. His plan has no fixed or removable prosth coverage, but he is telling my office that we have to honor the insurance rate for the crown and we cannot charge him the UCR.

My understanding is that is not correct because the crown D2740 is not a covered item in this case, and we are allowed to charge UCR, but pt is claiming that his insurance (everyone's favorite that starts with a D) told him that we have to discount it. Who is right? and how do you handle this in your office?