Am I supposed to pay a participating dentist any money?

Participating Providers

The Fund has contracted with many local dentists to provide dental services for Fund members.  What this means is that, if the Fund covers the service, and you are eligible for benefits for that service (frequency or time limitations may be something that might make you ineligible for reimbursement for a particular service),  there should be no out-of-pocket expense for you.

A participating dentist may not charge you any money before the Fund has had an opportunity to look at the claim and see exactly what will be paid or not paid.   If, for some reason, a particular service is not paid by the Fund, you are responsible for making payment to the dentist for the service.  Once you receive your copy of the EOB (Explanation of Benefits), the amount that you owe the dentist will be shown in the column marked “Fee Requested”.  Make sure you look at the EOB to see if any additional comments have been added for that particular service.  For instance, sometimes the Fund will not make payment on a particular service because it is included in another service that the Fund has already paid for.  In cases like this, you are not required to pay anything additional.

If the dentist’s office is asking you to make payment for something that you have not seen on an EOB, let them know that they cannot ask you for payment until the charge is first submitted to the Fund.