Dental Insurance EOB Question

Hi, so we recently took my son for a dental exam. The doctor said he needed two sealants but that they would need to send him to another office because they didn't do pediatric sealants…which I thought was strange because they are listed as a pediatric dentist, but anyway.

When we got to the office for the sealant appointment they said we owed $316. We hadn't had this done before and I just assumed that this wasn't entirely covered by our insurance. Well, I just got our EOB, and it says that our portion is $0. I called the dental office and they said, well that $316 was what the insurance wouldn't pay. Is that not balance billing and illegal (I am in California if that matters)? Are providers not required through their contracts to honor what is agreed upon with the insurance company on what they can bill?

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For clarity, the EOB says the following:

Submitted Fee: $811

Accepted Fee: $197

Insurance pays: $39

Your Cost: $0.00

At a minimum, I should have only been charged $158 (the difference between the accepted fee and what insurance pays, correct?)

I just want to make sure I know what I'm talking about when the dental office calls me back. Since I already paid, is there any hope of getting a refund?

Thank you so much!

submitted by /u/Dangerous-Cupcake24
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