Simple vs Surgical Tooth Extractions and Other Billing Concerns

by A concerned patient and caretaker

I have a great granddaughter age 8 who lives with me and receives Medicaid. I was able to find a dental office in town that accepts Medicaid. Having retired from our local social service agency I knew that most practices did not like to accept Medicaid patients. When I commented to the hygienist that I was thrilled to find a practice that accepts Medicaid since most dentist did not feel it was profitable to accept Medicaid. She said other practices just didn't know how to bill Medicaid.

Another concern is that when you leave this practice you get a card with your next appointment and a couple of samples. This is true not only for my granddaughters Medicaid billing but also my visit which is filed with my dental insurance.

Recently I had to have my remaining 6 upper teeth removed and dentures. When we started talking about this, I was told that it would be cheaper for me to pay in advance and file the insurance myself even though my insurance provider was in network. The office submitted a form to my insurance company so that I would know how much I would need to pay up front. When I got the estimate back I noticed that they have filed for the surgical removal of all six teeth, three on each side beginning with the canine teeth. When I questioned the need to surgically remove all six of the teeth since all were clearly visible. The hygienist said this was routine and I would only be billed for a regular extraction of they did not have to surgically remove any.

Subsequently, my teeth were pulled and when I received the eob from my insurance carrier it stated the amount they had paid to my dentist which included the surgical removal of all six teeth. I questioned this with the billing department and was told all six teeth required surgical removal. I went in for my cleaning on my lower teeth and questioned my dentist about this as I only had stitches in two sites that had bled. He stated that if they had to put in stitches or move any tissue aside that this was a surgical removal. They did refund the amount the insurance company paid them since I had paid in full the day I had the work done.

I would also like to add that this practice has recently built a new state of the art facility. Do I have reason to be concerned.

Reply:


I'm not sure what your insurance or Medicaid is being billed but you have the right to know and either accept or refuse treatment.

I feel they should ask before assuming you want a bag of samples - or before anything that you are going to be charged for. Many dental offices give a free toothbrush, toothpaste and floss after a cleaning. Sometimes products are sold through dental practices but it should always be your choice to buy or not.

Regarding your extractions: Simple extractions do sometimes turn into surgical ones if part of the tooth breaks while being extracted. I would imagine you would notice this during the procedure but maybe not if you were sedated. In any case, ideally you should have been informed before, during and after the treatment.

Paying upfront for the full amount is new to me especially after the work was pre-authorized and the dentist was in-network. It seems to just create work for the dental office and make it inconvenient for the patient.

There is nothing wrong with state of the art facilities if you are happy with everything else in a dental practice. But it is only part of the package. A dentist who puts your needs and priorities first and treats you with honesty and fairness is top on my list.

I'm so sorry you have these questions and doubts. It is stressful enough having 6 teeth extracted without this added worry.

Thanks for writing,
~Shelly

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