Re: [ACEsthetics] Insurance puzzle - your guidance and experiences..on biling combination or large cases to dental insurance

Gotta be careful using procedures which are bundled. It is MUCH safer using ones that are not covered at all, like whitening. As you say, there may be others, and if there are, I agree 100% that you should use as many as you can find. For it to work, you've got to at least have ONE though. If all you are doing are covered procedures, you may be hosed. See my response to Chris Hill. I was not suggesting to ONLY do it with one procedure UNLESS that is the only non-covered procedure you can find. It IS better to use multiple codes and divide the fee amongst them.

DRB

On Jul 29, 2013, at 7:45 PM, "Lance Timmerman" <bigdrtim@hotmail.com> wrote:

probably works.

 

but I would expand it out a bit more.  Instead of 24K for whitening, charge 10K for provisionals, 3K for occlusal determination, etc....  gets the whitening fee to look more normal.

 

consider ALL the nitty gritty that is normally bundled in our fees.

 

 

From: David R. Boag DDS

Sent: Monday, July 29, 2013 4:16 PM

To: arunnayyardmd@gmail.com

Cc: Ace

Subject: Re: [ACEsthetics] Insurance puzzle - your guidance and experiences..on biling combination or large cases to dental insurance

 

The only thing I have been able to figure out is to ensure that there is ONE procedure that you are doing as a part of the tx plan that is NOT covered by the patient's insurance plan. One possibility would be tooth bleaching. Give the patient a comprehensive treatment plan that is NOT itemized, and then the way you justify the fees is to charge the contracted fees for ALL procedures which are covered by the pt's plan, and then on that one procedure that is not covered, charge the remaining fee, no matter how large it might be.

 

So for example, in your example case below:

 

22 units of c&b @ $900 per unit = $19800

In-office tooth whitening = $24,200

 

Total = $44,000

 

The financial arrangement should be the case for $44K, signed by the patient. You send to ins @ 900 per unit. You make sure that the patient knows that to do the case right, you are going to work the system so it is fair, and for them not to sweat numbers that might seem ridiculous (like that whitening fee).

 

Legal. Patient gets the best care. No broken contracts. Fees are appropriate.

 

David R. Boag, DDS

 

 

On Jul 28, 2013, at 10:40 PM, ARUN NAYYAR <arunnayyardmd@gmail.com> wrote:

Hello All

 

I am mentoring a young Prosthodontist and he is hitting a wall with his fees.

 

He says he is signed with Delta Dental and another Dental Ins co.

 

His dilemma is that he is doing large combination cases or FMX

 

Several or most of you see this routinely and have a lot of wise counsel.

 

I am totally failing on this issue since I have no experience.

 

SO how does a fee for service practice survive until it builds a referral pool??

 

For example he has a patient with a $900 per crown fee and a 3000 limit??

But his fee for 22 units is 44K   this includes removing crs, buildups interim restorations, post op and finally restorations.  A 6 month plan

________________________

 

What will the ins co say to him if he charges $900 + 300 per unit for lab fee

 

How do YOU handle such a complex multiple appointment tx.

 

Doe sthe ins co control ALL charges once you are under contract

 

Do they have special fees for a Prosthodontist.

 

Anyone know of and use insurancesolutions.com

 

If you wish to email me privately with actual examles,  I will greatly appreciate this

 

Thank you

 

Arun

 

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