the insurance companies are the ones to blame! they are the ones who decided what is/isnt covered. Dentists, at least the ones i've worked with over the years, genuinely want to help their patients, but still need to cover employee salaries, lab fees, equipment etc. its insurance that leaves the patients with these insane balances. As an OM i am sometimes truly shocked by how shady and sneaky these policies can be with the fine print. we send in pre-auths, give the patients the estimates, and then the insurance will come back with an EOB so far off from the estimate. The only thing the office can do is try to appeal it and offer a payment plan unfortunately.