Insurance Non-Covered Services Q&A

Non-Covered Services by State. States not included do not have state legislation at this time.

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

This state is very vague on definition of non-covered services, all they state is:

"Covered benefits" or "benefits" means health care services to which a covered person is entitled under the terms of a health benefit plan.

The simplest interpretation of this is if the policy reimburses any amount, you charge network fee. If there is no reimbursement for the service, then you can charge full fees for all the below questions.

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

This state does not define covered services, it only says:

A participating provider agreement shall not require a participating provider to provide services to an enrolled participant at a fee set by or subject to the approval of the limited health service benefit plan unless the services are covered services under the provider agreement.

The simplest interpretation of this is that covered means reimbursed. If the policy reimburses any amount, you charge network fee. If there is no reimbursement for the service, then you can charge full fees for all the below questions.

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

The law does not specify what covered services means.

A dental services contract may not restrict the price that a provider may charge for services provided to an enrollee unless the services are covered by the insurer.

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

The unique clause for Tennessee is:

“Covered services” means services reimbursed under the dental plan that pays at least fifty percent (50%) of the dentist's prevailing fee, administered consistently with policies traditionally governing covered services.

If a crown is only covered at 49% or less, that service now becomes “non-covered” and therefore at full office fee.

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Insurance Non-Covered Services Q&A

Non-Covered Services by State. States not included do not have state legislation at this time.

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

This state is very vague on definition of non-covered services, all they state is:

"Covered benefits" or "benefits" means health care services to which a covered person is entitled under the terms of a health benefit plan.

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

This state does not define covered services, it only says:

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

The law does not specify what covered services means.

A dental services contract may not restrict the price that a provider may charge for services provided to an enrollee unless the services are covered by the insurer.

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

The unique clause for Tennessee is:

If a crown is only covered at 49% or less, that service now becomes “non-covered” and therefore at full office fee.

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Insurance Non-Covered Services Q&A

Non-Covered Services by State. States not included do not have state legislation at this time.

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

This state is very vague on definition of non-covered services, all they state is:

"Covered benefits" or "benefits" means health care services to which a covered person is entitled under the terms of a health benefit plan.

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

This state does not define covered services, it only says:

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

The law does not specify what covered services means.

A dental services contract may not restrict the price that a provider may charge for services provided to an enrollee unless the services are covered by the insurer.

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

The unique clause for Tennessee is:

If a crown is only covered at 49% or less, that service now becomes “non-covered” and therefore at full office fee.

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Insurance Non-Covered Services Q&A

Non-Covered Services by State. States not included do not have state legislation at this time.

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

This state is very vague on definition of non-covered services, all they state is:

"Covered benefits" or "benefits" means health care services to which a covered person is entitled under the terms of a health benefit plan.

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

This state does not define covered services, it only says:

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

The law does not specify what covered services means.

A dental services contract may not restrict the price that a provider may charge for services provided to an enrollee unless the services are covered by the insurer.

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

The unique clause for Tennessee is:

If a crown is only covered at 49% or less, that service now becomes “non-covered” and therefore at full office fee.

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Insurance Non-Covered Services Q&A

Non-Covered Services by State. States not included do not have state legislation at this time.

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

This state is very vague on definition of non-covered services, all they state is:

"Covered benefits" or "benefits" means health care services to which a covered person is entitled under the terms of a health benefit plan.

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

This state does not define covered services, it only says:

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

The law does not specify what covered services means.

A dental services contract may not restrict the price that a provider may charge for services provided to an enrollee unless the services are covered by the insurer.

The alternative interpretation is to go by what most states that do define as “covered”, and therefore the questions would have the following answers:

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

The unique clause for Tennessee is:

If a crown is only covered at 49% or less, that service now becomes “non-covered” and therefore at full office fee.

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Question	Network Fee	Full Fee
My patient’s insurance is maxed out; can I charge them full fee or network fee?
My patient is under frequency limitation on their treatment; can I charge full fee or network fee?
My patient’s insurance is reimbursing nothing due to a deductible; can I charge full fee or network fee?
My patient’s insurance paid a downgraded/alternative benefit; can I charge the patient full fee or network fee?
My patient’s insurance will not reimburse due to an age limitation on their treatment (ortho, fluoride, etc.); can I charge the patient full fee or network fee?
My patient needs restorative work on the anterior, but insurance does not reimburse for abrasion/abfraction/wear; can I charge the patient full fee or network fee?
My patient has a waiting period for treatment; can I charge them full fee or network fee?

Insurance Non-Covered Services Q&A

Insurance Non-Covered Services Q&A

Insurance Non-Covered Services Q&A

Insurance Non-Covered Services Q&A

Insurance Non-Covered Services Q&A

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