January 19, 2023 • 3 min read

An Updated Medical History Can Mean the Difference Between Approval or Denial on Claims

Case Summary: Exam, Bone Graft, Membrane




Updated Medical History

Case Summary: Exam, Bone Graft, Membrane

State: New York

 Amount Billed: $1475

Amount Paid: $987.38

Insurance Carrier: Regence

This 43-year-old patient presented with pain in the lower left and was concerned about the long-term health of her tooth. 

A review of her medical history showed that she took medication to treat her Lupus, which is known to cause dry mouth. Upon examination, the dentist confirmed that the condition of #18 was consistent with caries due to dry mouth. 

It was determined that #18 was a non-restorable tooth and would require extraction, grafting, and a membrane to preserve the current bone level and prevent further atrophy.  Because this practice asked all the right questions on their medical history, they were able to prove the medical necessity for these dental procedures.  

The practice billed $1475, and the insurance paid $987.38.  Saving the patient nearly $1000 and saving dental benefits for other dental needs.

Contact us at (855)-534-1433 to see how we can help you get more success in billing medical insurance for Dental procedures! 

Updated Medical History

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