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Asked: Apr 28, 2010

I have an Aetna Dental PPO Plan through my husband's employer…

I have an Aetna Dental PPO Plan through my husband's employer. The plan initially covered 80% of a root canal procedure, and I paid 20%. Later on, I was billed for 30% more of the cost of the procedure. It turned out that the employer downgraded the dental benefits. Should I pay for the additional 30% even if we were not informed of the changes made to the plan?

Categories: In Texas

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It is the employer's responsibility to notify its employees about the changes in the coverage of their health policy, including changes in your husband’s Aetna Dental PPO Plan. What probably happened is that the employer downgraded the policy to reduce the premium payments of both the company and the employee. There are probably 10 or more different Aetna Dental PPO Plans that the employer can choose from which have different co-pays and percentage payments on certain items and procedures. You can try calling your husband's employer to ask about when the change in his Aetna Dental PPO Plan occurred and what the other policy changes are. You should also communicate with the dentist's office, since you have a better chance with them at reducing the balance than having Aetna pay more of your dental procedure. It is also the responsibility of the dentist’s office to check with Aetna and find out your plan coverage – something which the dentist’s office wasn’t able to do. Legally, you are liable for any balance in co-pays that your husband's Aetna Dental PPO Plan won't be paying for. Try to talk first with the dentist's office and the employer before paying the additional 30% in the cost of the procedure. - June 11, 2009 @ 5:11 pm

Answered: Apr 29, 2010

 

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