Dental Question

[LostDollar]

yea she just was told it was going to be a cleaning till they took xrays and she was in the chair

There you go, There is more than the cleaning code involved. There is likely also a D++++ dentist examination code involved too. You really can not comment intelligently on this to your client unless

if the service is already done, you see a copy of their statement of account showing each D++++ code involved for the visit and the charges assessed,

or

if the service is yet to be done, a complete estimate, listing all dental code services to be done and the charges to be assessed.

I am not taking the time to go look codes and charges up right now, but a normal twice a year cleaning visit, for most people would likely involve a D1110 cleaning charge, a D0210 dentist evaluation charge, and bite wing xrays.

I would guess a deep cleaning code plus a dentist new patient or pain evaluation code plus full mouth xrays might easily get to that $700 amount.

(and if she goes to another dentist, and doesn't get xrays transferred, or maybe even if she does, she will have additional xray charges at the new dentist. She will also have another new patient or pain based provider exam code, and her policy may only cover one of those per plan year.)

 

[LeeV]

yea she just was told it was going to be a cleaning till they took xrays and she was in the chair

I knew there was more to the story. Glad you were able to help them.

 

[Special Agent]

I have a client on Ameritus and she went in for a cleaning and was told it was a deep cleaning and after insurance paid $75 she owes $700

Does that even make sense even if one does not have insurance ?

2nd if it all makes sense does anyone cover better? CUL?

first mistake was going to in network dentist of any dental plan they almost always play games with charges to makeup for the low reimbursement .I personally learned this the hard way and finally found an good honest dentist who will bill my M edico ppo dental OON. those calls you get from clients who are at their dentist office are never fun that's why i hardly ever write dental plans.

 

[bill3173]

$700 is way over the top for that service including exam and x-rays. The periodontal scaling is ~$140-$160, panoramic x-rays $100-$200, and exam charge $40-$80. I could have sent her to a qualified periodontist almost anywhere in the Carolinas and her total would have been less than $400.

I do a lot of dental insurance, and assist in the self filling cases, and have for many years. I've never seen anything close to that amount for the services that you outlined.

 

[LostDollar]

$700 is way over the top for that service including exam and x-rays. The periodontal scaling is ~$140-$160, panoramic x-rays $100-$200, and exam charge $40-$80. I could have sent her to a qualified periodontist almost anywhere in the Carolinas and her total would have been less than $400.

I do a lot of dental insurance, and assist in the self filling cases, and have for many years. I've never seen anything close to that amount for the services that you outlined.

Those are good points, charges may vary from one area of the country to the next.

However, as I suggested earlier, you can't make any absolute definitive statements about the case without seeing an EOB and knowing the specific Dental Codes billed and the billing amounts.

To start with, as an example, the exam charge could have been for a new patient exam, which would have been higher. And your estimates for a regular exam seem low to me.