My son recently had 2 wisdom teeth removed. I asked my ex-wife to confirm which insurance it would use and the cost out of pocket to us before he had the surgery. They told us it would be covered by health insurance. My health plan info online seemed to concur. I got an explanation of benefits from health insurance showing they paid everything (except the $25 copay). No problem.

Today I got another explanation of benefits from Delta Dental showing billing for the same thing, 2 teeth extracted (although price was about half what Health Insurance paid) and 3 anasthesias at about the same price health insurance paid.

The delta dental says my responsibility is about $340. I wasn't expecting that but I didn't get a bill yet either. Is it possible the dentist scammed and billed both places or is this something where the health insurance picks up what dental doesn't or something like that?

It cost me less than $340 to get both wisdom teeth out a few months ago with NO insurance. Something is weird here.

Were the diagnostic codes the same on both EOBs?

quote:

Originally posted by bobtheelf:
It cost me less than $340 to get both wisdom teeth out a few months ago with NO insurance. Something is weird here.

Nothing really weird. Cost depends on how impacted. He is only 14. The teeth were not out yet. But x-rays showed they would be seriously impacted and ruin the correction from braces that he just got off.

quote:

Originally posted by MNSIG:
Were the diagnostic codes the same on both EOBs?

The codes aren't the same but the descriptions are.

My ex wife confirmed she was told we would not have anything out of pocket other than the $25.

Hmmm.... I was originally going to guess that your health insurance is insurance and your dental is a traditional indemnity plan and that you were seeing the stacking. Funny that the codes would be different, except that it's possible that one of the two is still using ICD-9 codes, but they should be the same from the provider and reflected accordingly on the EOBs.

Since I sort of do some of this for a living (and have people that do it exclusively for me), I'd be happy to take a look and see what sense I can make of it if you want to shoot the EOBs my way. All confidential, of course.

-Rob

Is your son covered by two insurance policies? Perhaps it is a coordination of benefits issue.

quote:

Originally posted by BurtonRW:
Hmmm.... I was originally going to guess that your health insurance is insurance and your dental is a traditional indemnity plan and that you were seeing the stacking. Funny that the codes would be different, except that it's possible that one of the two is still using ICD-9 codes, but they should be the same from the provider and reflected accordingly on the EOBs.

Since I sort of do some of this for a living (and have people that do it exclusively for me), I'd be happy to take a look and see what sense I can make of it if you want to shoot the EOBs my way. All confidential, of course.

-Rob

Thanks Rob. I think I'll wait just to make sure I don't get bill. If I get a bill I'll look into it a bit more.

quote:

Originally posted by ZSMICHAEL:
Is your son covered by two insurance policies?

He's covered by dental insurance from one company (Delta Dental) and health insurance from blue cross (Horizon Blue of NJ). My understanding from the ex was that it was going through health insurance due to impacted teeth. But when it comes to money stuff she doesn't pay attention to details so it's hard to know what she was told.

quote:

Originally posted by bobtheelf:
It cost me less than $340 to get both wisdom teeth out a few months ago with NO insurance. Something is weird here.

Sidenote. I live in Silicon Valley. I can fly to Salt Lake and back to get a dental crown, pay for the whole thing, including airfare, for less money than going any dentist within 15 miles for the same crown.

Yeah I would wait. Insurance companies have entire departments called OHI, that make sure they do not overpay. It is a process of determining which company is responsible, and for what procedures. My guess is you will not owe anything.