Case Summary: Implants, Grafting, and Sedation

State: Buffalo, NY

Amount Billed: $14,963.50

Amount Paid: $10,122.10

Insurance Carrier Billed: United Healthcare

The patient presented with jaw pain, inability to chew, and difficulty swallowing. A thorough exam was completed, and it was determined that he could not properly macerate food due to his missing teeth. The malocclusion was also causing jaw pain and inflammation. 

The ICD-10 diagnosis codes we used were:

R13.19 – Other dysphagia

M27.2 – Inflammatory conditions of jaws

K08.22 – Moderate atrophy of the mandible

Due to these medical issues and the effect these conditions can have on overall health, the medical insurance paid $10,122.20 of the $14,963.50 claim.  Leaving the patient an out-of-pocket portion of $4,841.30.  A savings of over 90%. 

The practice billed their full UCR (Usual, customary, and reasonable out-of-pocket fees), even though they are contracted with most dental plans. Therefore, they could collect 100% of their FULL FEE between the patient and medical insurance coverage. 

Without medical insurance, the patient would have been limited to their $1,500 max dental benefit. The practice would have been subject to their dental PPO fee adjustments and would have collected approximately $10,000 at the reduced fee schedule. The patient would have owed $8,500 out of pocket.  

So not only did the patient save over $3600  because medical insurance was billed, but the practice collected an additional $4,963 that they would not have collected had they not billed medical insurance. 

In stories like these, everyone wins. Patients may be unable to afford that $8,500 for dental services, but the $3,600 in savings can make even a hesitant patient proceed with treatment. Had the practice not billed medical insurance and the patient chose not to move forward with their treatment, the practice would have made nothing and the patient would still be suffering.  

This claim was submitted a year after the procedure was complete and had been denied for a timely filing. With the diligence of the Imagn Billing team, we were able to get the denial overturned and the claim processed and paid!

Contact us at (855) 534-1433 or Support@Devdent.com to see how we can help you be successful in billing medical insurance for Dental procedures!