Impacted Wisdom Teeth Exaction with IV Sedation, billing questions
Hi everyone, I’d like to seek advice. I am an NG and new hire who recently activated Blue Cross Dental insurance PPO plan and HPHC medical insurance PPO plan from my work. I have 4 impacted wisdom teeth and had a consultation with an oral surgeon at MGH, his coordinator provided me with dental codes and told me I am responsible for paying a total cost of $2166.50 due at the appointment of my surgery day. She said MGH won’t bill dental insurance given my medical insurance covers my procedure. Medical covers 90% of costs (patient pays 10%) after the deductible is met of $1600.00. Given my case, the deductible has not been met. This would equal $1600.00 + $566.50 (10%) = $2166.50. She highlights they do not submit pre-estimates for dental. And regardless there is no way, even with a pre-estimate for the dental to calculate the coordination of benefits that would occur with my medical plan coverage. Also, the only codes that will be billed are the ones I was provided. No medical codes are billed. This is a dental procedure and the dental codes provided will be the codes billed to insurance.
So I was confused, why she could not bill two insurances together after my extraction will be completed on 10/16/2024, I was concerned that no one confirmed whether I could get my dental covered and refunded if my medical insurance covers some, the biggest issue for me is the $1600 deductible I have to pay myself first. That’s a big amount for an NG like me…
She said:”This is the process at MGH: 1. You pay our estimate. 2. Once your procedure is done, billing sends the claim to your medical insurance. 3. Once that claim has fully processed and the insurance has paid (could take up to 90 days), we can send the claim to the dental insurance. On the dental insurance side they will then process the claim. If they cover something within their coordination of benefits contract with your medical they would send a payment to us. 4. At that point, you may have a credit at MGH which can be refunded to you in the tender that you paid with (this means, if you pay with a credit card, it will be credited to that credit card).
There is no way we can estimate if your dental insurance will or will not pay anything once the medical has been paid. This is why our process is as such. Insurances, whether medical or dental, give no guarantee of payment. And we do not know what the coordination of benefits contracts are between insurance companies. I know you are trying to understand this fully, but I have answered everything as best as I can. And the is no other answers I can give. I understand it is a lot of money due to your medical plan having a deductible and that deductible not being met. But this is the process. If you are unable to pay the amount or you are not comfortable with our process you can cancel your appointment and go to another location for your procedure on 10/16″
I tried to ask my dental insurance but they insisted on requesting MGH to submit an estimation – which was denied by MGH, dental insurance also doesn’t provide me an answer for how much dental insurance will cover, so I don’t know how to ask for dental insurance in this way.
Dental Insurance said “I have no way of knowing what your cost will be. I don’t know how they will submit the medical claim and what the coding will be. And I don’t know what the dental will pick up after that.
If you are worried about paying all of this upfront and waiting to be reimbursed, it might be worth looking into other oral surgeons. This is the policy of that particular provider, but it won’t be the same everywhere.”
I wonder if anyone else like me going through this completing payment first and receiving a refund later process??
Thanks,
Betty
