fees for root canal and crowns Posted: 03-14-08 21:09pm
After many years of terrible neglect, I
overcame my avoidance of dentists. It was
in large part because of $$, but also
because of bad experiences.
So now I have what seems to be good
insurance and a good dentist. She filled a
zillion cavities and seemed efficient and
competent.
To complete the project, I need three root
canals (3, 30 and 31). She doesn't do the
actual root canals on molars, so is
sending me to a specialist for the D3330s.
Here is the problem: The costs according
to the benefit schedule seems clear, but
she's tacking on misc D999 fees.
It would seem that my fees would be (per
tooth):
-D3330 - $64 (at Endodontist, already
confirmed cost. They say they get a decent
reimbursement .)
At dentist:
-D2950 Crown Buildup- $59
-D2790 crown - $150.
Pretty darn good, but she's adding D999
"unspecified procedures" of $150 per tooth
for "lab fees", and another D999 of $101
for "study models" once. Can she do that?
She says that the copays don't cover the
costs, so she has to add the extra fees.
As far as I understand, I have an
agreement with the insurance company that
the listed items cost as listed. She has
an agreement with the insurance company to
provide services for the prices listed. So
to do otherwise is a breach of the
agreement.
I can understand that if a dental code
isn't listed, like I believe that a cavity
can be "lined" prior to filling and that
my insurance doesn't cover it. So that's
an actual dental coded procedure that she
thinks is medically necessary, but isn't
covered. OK, but just gluing a fake D999
because she wants more money seems
unethical.
From what I understand, it's a roster type
insurance. She gets around $12 or $13 a
month no matter what she does. Then there
are very low co-pays for many procedures
($6-$13 per cavity, depending on number of
surfaces, etc). A ton of procedures are
free for me.
So for people like me with crappy dental
hygiene and a ton of problems, I'm not a
good patient financially for her. But if
she has 3000 patients, she gets ~$36K a
month. If she can keep people healthy she
might do OK. For every crap patient like
me there are some "good" patients (just
need cleanings or doesn't come at all). It
will balance in the end if she's efficient
with issues as they come up. Now that she
fought off all the issues other than the
root canals, I should be good for a
while.
So is this acceptable practice? Should I
push it with the insurance company? If I
fight it and am able to force the issue,
it's going to make for some awkward open
mouth sessions.
For me, it makes the difference of getting
it done, or continuing to let it slide
because I can't afford it.
|
Carifairy
Extremely EHEALTHy
Joined: 12 Nov 2005 Posts: 2533 Location: Charlotte n.c.
Thanks: 9
Thanked:0
Posted: 03-14-08 22:00pm
In order for crowns to be MADE by the
actual lab, you have to have a study model
made.
YES, those charges sound reasonable.
Because you do not go to the dentist
often, you probably are not up to date on
costs associated with dental care and
procedures.
|
tommr
New User, Becoming EHEALTHy
Joined: 26 Feb 2008 Posts: 18
Posted: 03-15-08 06:40am
Carifairy
wrote:
In order for crowns to be
MADE by the actual lab, you have to have a
study model made.
YES, those charges sound reasonable.
Because you do not go to the dentist
often, you probably are not up to date on
costs associated with dental care and
procedures.
But I have insurance! If my regular doctor
charged me $15 as a copay, then charged me
extra for everything he did because he
didn't think the insurance gave him
enough, the insurance company would drop
him like a hot potato.
If a blood test is listed as a covered
item, and the insurance only paid him $50
for it. Even if he thought that it wasn't
enough, he can't change me more. That's
between him and the insurance company. If
he doesn't like the reimbursement, he
shouldn't accept that insurance.
The roster dental insurance isn't like a
buyer's club type of dental insurance. She
took my $12 a month for almost two years
before I even walked in the door. Other
than rc/crown, I'll show up twice a year
now for cleaning and that will likely be
it. And she'll continue to get my $12 a
month along with all the other people who
have my same insurance.
Study models may be normal, but why
doesn't it have a dental code?
|
bbfeet9
Experienced User , Rather EHEALTHy
Joined: 05 Feb 2008 Posts: 62 Location: ,
Nothing to do with insurance Posted: 03-18-08 10:34am
Just so you know, i had 4 root canals 1
year ago. 2 of my teeth are loose now.
They are in the back, but still. I should
have had them extracted and a bridge to
replace them. Some root canals take, some
don't. Mine didn't. I am upset cuz my ins.
does not provide a hugh $$$$$ amount for
dental. We had to pay for the caps to the
tune of 800.00 a piece. Talk about
disgusted.
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