Guardian Dental - helping understand guardian dental
Hello! I have Guardian Dental insurance. I just received a bill where I am responsible for $217 - Guardian only paid $47.00. Services billed were D0120 and D4910 (Periodic Eval and Periodontal Maintenance). I went on my Guardian account and it says that both codes are covered 100%. They are both under preventative and the coinsurance is listed as 100%.
"Detailed and extensive oral evaluation (D0160) is not covered. **Oral evaluations, including codes** ***D0120***\*\*, D0145, D0150, D0170, D0180 or D9430, are covered once in any 6 consecutive month period.\*\* The limited oral evaluation - problem focused (D0140) is not included in the frequency limitation or last visit date."
"Periodontal maintenance (D4910) is covered under the Basic service category. Adult prophylaxis (D1110) is covered age 12 and over. Prophylaxis (cleaning) (D1110, D1120) or **periodontal maintenance (D4910) is covered once in any 6 consecutive month period."**
My date of service was 3/6/25. I have not had any other services in the last six months. My last visit was 9/3/2024. My deductible is $50, "Yes" means waived for preventative. To date, I met the $50 deductible and Remaining is "0".
|| || |Individual Dental|Out of network|$50.00|Yes|$50.00|0| ||In network|$50.00|Yes|$50.00|0|
My deductible is $50 and it says I paid it... and my coinsurance is 100%? So even for preventative services, this means I'm responsible in paying all of my dental care beyond the first $50? My yearly plan limit is $1000. What is even the point of having health insurance? Is this because I got basic coverage instead of full coverage? I guess I'm ignorant and thought that preventive care would be covered. I feel really stupid right now! I tried calling, but they aren't open. Any assistance to help me understand is appreciated.
Make A Complaint
Loading...