Everything You Need to Know about Dentist Balance Billing

managing dentist balance billing

When you visit the dentist, you may be asked to pay a balance after your insurance has paid its share. This is called balance billing, and it can be a shock if you’re not expecting it. But there are ways to avoid it.

What Is Balance Billing?

Balance billing happens when your dentist charges you for the portion of the bill that your insurance doesn’t cover. For example, if your dental insurance has a $1,000 annual limit and your dentist charges $1,200 for a procedure, you may be responsible for paying the $200 difference.

While your insurance company may have negotiated a lower rate for dental services, you are still responsible for paying the full amount if your dentist’s balance bills you. This can be a significant expense, especially if you have multiple procedures done.

Why Do Dentists Balance Bill?

Dentists may balance the bill because they don’t participate in your insurance plan. This means they haven’t agreed to accept the insurance company’s payment terms. When you visit a non-participating dentist, you’re responsible for paying the full cost of treatment. Your insurance company may only cover a portion of the bill, and you’ll be responsible for paying the rest.

How Can I Avoid Balance Billing?

The best way to avoid balance billing is to visit a dentist who participates in your insurance plan. You can find a list of participating dentists on your insurance company’s website.

If you need to visit a non-participating dentist, you can ask about their policy and an estimate of the cost of treatment before you have the procedure. This way, you’ll know how much you’ll need to pay out-of-pocket. 

You can also ask the dentist to submit a pre-treatment estimate to your insurance company. This estimate will outline the expected cost of the procedure and may help you get approval for the treatment.

Once dental work is completed, ask for a detailed bill that itemizes all charges. This way, you can compare the bill to your insurance company’s explanation of benefits to ensure you are only being charged for what is covered.

If you are ever presented with a bill that you feel is too high, do not hesitate to ask for an explanation of the charges. Your dentist should be able to provide a breakdown of the services rendered and the associated costs.

If you’re still having trouble, you can always seek help from a dental advocate. These professionals can help you understand your rights and options, and they may be able to negotiate on your behalf.

What If I Can’t Afford to Pay the Balance?

If you can’t afford to pay the balance, you can ask the dentist to set up a payment plan. You may also be able to negotiate a lower fee.

You can also file a complaint with your state dental board if you feel you’ve been unfairly balance billed.


Dentist balance billing is when a dentist bills a patient for the remaining balance after insurance has paid its share. This can happen if the dentist is not in the patient’s insurance network or if the procedure is not covered by insurance. 

While balance billing is legal in most states, it can shock patients who expect their insurance to cover the entire procedure cost. 

Patients can avoid balance billing by doing their research ahead of time and finding a dentist in their insurance network. If a procedure is not covered by insurance, patients can ask their dentist about the cost upfront, so there are no surprises later on.

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