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Medical Forum / General / Dentistry / August 2006

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Where Can I find billing codes and suggested reasonable charges for the repair of a filling

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DaileyJohn.20.decij@spamgourmet.com - 05 Aug 2006 23:15 GMT
About 3 weeks ago I posted a question about the reasonableness of
a $168 charge for the repair of a filling (cutting two grooves in the
filling and putting resin in the grooves) that took about 25 minutes in
Cincinnati.  (The dentist never told me what the charge for the
procedure would be.)  Since then I have gotten a bill and the insurance
company refused to pay for the filling.  (I had maxed out my benefits).
Someone suggested that there are tables containing what insurance
companies will agree to pay for certain procedures, but I have been
unable to track down the tables.  The dentist never told me what the
charge was, and it seems high to me.  However, if insurance tables
confirm that the charge is reasonable, I will pay the bill.  If the
tables show the charge is significantly higher than the tables, I will
have a discussion with my dentist.  Could someone please tell me the
best way to locate the tables on the web?  

Thanks,

JD
Steven Bornfeld - 05 Aug 2006 23:36 GMT
>       About 3 weeks ago I posted a question about the reasonableness of
> a $168 charge for the repair of a filling (cutting two grooves in the
[quoted text clipped - 14 lines]
>
> JD

    This is a good question--wish I had a good answer for you.
For those insurance companies that have reduced-fee participating
dentist programs (PPOs) the fee schedules can sometimes be obtained on
line (though I'm not sure you can access these if you aren't a member).
    But as far as what insurance companies consider reasonable (so-called
UCR--usual, customary and reasonable) are usually secret.  It is usually
defined as the 90th percentile (that fee at and beneath which 90% of
dentists' fees fall--sometimes broken out by locale).
    Problem is, some insurance companies maintain UCR lists that are years
(sometimes many years) out of date.  In a rare instance of candor, years
ago an insurance company rep admitted to me that they used a UCR list
that was about 15 years old, but that the next year they were upgrading
to a UCR list that was only 5 years old!
    The most absurd instance of this secrecy is the Delta Dental system.
If a dentist wishes to participate, they must sign a contract accepting
the delta fees.  Problem is, they don't tell you what the maximum
allowable fee is.  You submit your fee profile, and when you send in a
claim if your fee is over their max they reduce the fee to their max.
That is the only way you ever find out what their maximum reimbursement is.
    The only other thing I can tell you is that there are some throwaway
magazines that are sent to just about every dentist in creation--one
called Dental Economics (come to think of it, I don't think I get it
anymore) that once a year does a statistical survey of fees by region.
If you're near a dental school you might want to try to sneak into their
library and see if you can find a copy.  There is no way to tell of
course if their informal survey is truly representative, and my
impression is that the fees are generally quite high.  There are also
some practice management companies that survey and keep these statistics
(available for a fee).
    I found something on the web, and it may help you.  If you e-mail me at
dentaltwin@earthlink.net I can send it to you as an attachment.

Steve
Bill Gates(Email to me without 'this is not spam' in the subject is directed straight to the trash unread by automatic filters.) - 06 Aug 2006 07:25 GMT
Even though your insurance won't pay, they should still able to tell
you whether the charge is appropriate.  Ask 'em.  I suggest doing it in
writing (e.g. a lettter or fax).
For example, my insurance co was able to estimate how much the gold in
a porcelain/gold molar crown normally costs.  This info (and a lot of
diligence) saved me around $350!
DaileyJohn.20.decij@spamgourmet.com - 06 Aug 2006 18:09 GMT
Bill Gates(Email to me without 'this is not spam' in the subject is
directed straight to the trash unread by automatic filters.) wrote:
> Even though your insurance won't pay, they should still able to tell
> you whether the charge is appropriate.  Ask 'em.  I suggest doing it in
> writing (e.g. a lettter or fax).
> For example, my insurance co was able to estimate how much the gold in
> a porcelain/gold molar crown normally costs.  This info (and a lot of
> diligence) saved me around $350!

I wasted a half-hour with my insurer on the phone.  Its employees
didn't know how to handle the question, and I was hoping there was an
easier way to look this up.

I may try to call again if the information can't be located on the web.

Thanks,

JD
Tony Bad - 07 Aug 2006 04:24 GMT
Check your e-mail Steve.

T
DaileyJohn.20.decij@spamgourmet.com - 07 Aug 2006 22:53 GMT
I called the dentist's office and they said the code was D392.
Don't know what that means, but I will try to look it up.

JD
> >       About 3 weeks ago I posted a question about the reasonableness of
> > a $168 charge for the repair of a filling (cutting two grooves in the
[quoted text clipped - 48 lines]
>
> Steve
 
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