1 In-network, the percentage covered is a percentage of the negotiated fee. Out-of-network, the percentage covered is a percentage of the Maximum Allowed Charge.
2 Out–of-network reimbursement is based on the Maximum Allowed Charge, which is equal to the in-network negotiated fee.
3 Percentages are based on the Maximum Allowed Charge. If you visit an out-of-network dentist, you will be responsible for the deductible (if any), the percentage of the Maximum Allowed Charge that MetLife does not cover, plus any amount in excess of the Maximum Allowed Charge charged by the out-of-network dentist.
4 As a hypothetical example, a dentist’s usual fee in Jefferson City, MO 65110 for a crown might be $1,125. The In-Network Negotiated Fee/Out-of-Network Maximum Allowed Charge is $688. The percentage covered is 50%. Your In-Network out of pocket cost would be $344. The Out-of-Network out of pocket cost would be $781. This example assumes you have already satisfied the annual deductible.