Dentaltown January 2017 - 46

orthodontics
message board

$367! Remember, this is PPO and I cannot charge the balance. I guess I am going to have to
tell people that this is cosmetic ortho and is not covered by insurance. It just doesn't feel right
to do this, but it certainly is not right what the insurance companies are doing to us. Somebody
please tell me how you are getting around this! Rick, we have talked to Margie and she said we
are overthinking this stuff too much. I just don't see how. ■
4/5/2010

Andres Gamboa
Member Since: 01/25/05
Post: 55 of 115

Just offer them CareCredit. I don't mess with insurance (although for some reason my front
desk wants to). Just collect the money as an elective service. If patients are really hell-bent on
using their insurance, send them to the orthodontist for two-year comprehensive ortho. Present
this as an alternative for veneers-which insurance doesn't pay for. ■
4/5/2010

Ronan1
Member Since: 02/28/05
Post: 67 of 115

I give patients options-no treatment; Invisalign; Powerprox or comprehensive ortho-and
tell them advantages and limitations of each. Insurance will cover comprehensive ortho if they
have a rider for this coverage; otherwise, it's out-of-pocket for the others.
I tell them there is no insurance coverage for six-monthbraces. It doesn't fit into any categories
that is in CDT. I have an internal code. This is a mindset issue for you and your staff. I not being
mean-spirited; just trying to offer suggestions. ■
4/5/2010

Robberz
Member Since: 02/02/07
Post: 90 of 115

You are going through what I went through years ago when I learned how to "work with"
different insurance companies. What you and your OM need to do is, first, make sure you
confirm all the reimbursement amounts and rules (which it looks like you did in an earlier
post), then create a pitch to the patient to create a realistic expectation of the actual cost. Like a
few have said here, make the insurance company sound like a common enemy-one that is not
interested in their health, just in collecting their premiums and paying out as little as possible.
Getting back to your original concern, I use 8999. If they downgrade it, that doesn't mean
that they're telling you what you did, it means they're telling you what they'll pay on. For
example, I did a three-unit bridge on someone, sent in the claim and they actually denied the
three-unit bridge claim but sent a payment for a partial as alternative. Could you imagine if I
now had to write off the rest of the three-unit bridge and only get paid for a partial?! Of course
not. So communication with the patient is key. Make any insurance reimbursement they may
get seem like a surprise bonus-"found money," so to speak. ■
5/16/2010

drbraps
Member Since: 07/06/04
Post: 96 of 115

I am in the same situation and wanted to resurrect this thread to see if there is any new
information.
I want to use a sealant as a way of getting through my questions:
My sealant fee: $40. PPO fee: $28. Because I am in contract with the PPO, the patient
cannot be charged more than $28.
Several people in the thread say that you should just ignore the insurance and not bill it: I
am pretty sure that this is illegal according to their contract. (Not sure.)
My way of coding for ortho is by doing the following (I haven't found out if it is going to
work or not): Use comprehensive code for ortho 8090: $4,500. PPO fee: $3,500. Use 8999 code
for $1,000. Total of $4,500.
Insurance does not pay any of the 8999 code. The 8999 is 100% paid by the patient, so why
would insurance care what you charge?

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