toofache32 wrote:mouses wrote:toofache32 wrote:
Medical insurance very rarely pays anything for teeth. The biggest problem is finding a dentist to work on "contingency" to do the work and hope insurance pays....most (rightfully so) will require you to pay up front and it's the patient's fight to get reimbursed from THEIR insurance.
I think I'm correct in saying that everything that has ever been done to my teeth by an oral surgeon was covered by my medical insurance.
My experience as an oral surgeon has been exactly the opposite. I lost big on some cases before I finally saw the light and dropped all medical insurance so I would no longer be contractually forced to purchase my patients' healthcare for them. In my office I have a framed pre-authorization for an implant case. They decided not to pay and I had to eat over $10,000. Now that I am no longer in-network with medical, it's the patient's fight, not mine. There were many other more subtle gotchas were (on multiple occasions) they paid me $54 for a bone graft that cost me almost $200 just to purchase the graft. As an in-network provider there was nothing I could do. I was BUYING healthcare for my patients.
Contract of Adhesion: https://www.irmi.com/online/insurance-g ... tract.aspx
When I had my implant done, the oral surgeon sat down with me and explained it as follows. "The tooth has a crack in the root (as shown by the endo photos). There is a mild infection that the endo has treated. Leaving the tooth in place risks a medical problem. As a result, your insurance company will pay for the extraction (he checked). Since it is perfectly viable to close the gum and leave a gap, putting in an implant is not a medical necessity and not covered by your insurance. "
I had the means to go full implant. I did pre-pay for all the non-covered work.