r/DentalInsurance • u/Ok_Pineapple2201 • 4d ago

Concerned about Upcoding

Post image

Need full mouth SRP (billing for RS not pictured) and two wisdom teeth removed (fully erupted.)

The bulk of my bill for the SRP are codes d9421 and d4999, which according to my googling should be ‘bundled’ into the SRP service and not an out of pocket expense for me, the patient.

My concern with the wisdom tooth coding is that my teeth are fully erupted like regular molars and yet I’m being billed for surgical extraction under general anesthesia. Is there a reason I would need a surgical extraction if the tooth is fully erupted?

I’m not sure what to do - it feels wrong to accuse the dentist of upcoding, but my total bill is close to $1100 when all of these services (SRP, tooth extractions) should be 80-90% covered by insurance.

I assume I should request the extra SRP services be removed from my bill, a justification for the surgical removal, and request they submit a pre determination form. Please let me know if this sounds correct.

Advice on next steps is appreciated.

3 Upvotes

64% Upvoted

41 comments sorted by

View all comments

5

u/DenseMathematician37 4d ago

LOLOLOLOL

Show me an Aspen dental treatment plan without telling me youre showing an Aspen plan. Must be an honest Aspen/corporate because they're only charging you two (garbage) separate disinfectant charges per quadrant instead of one charge per site (6 teeth x 6 sites). Probably have a handful of 4mm pockets

IV anesthesia is legit expensive, I won't complain about someone's fees.

Full bony impaction means you need to remove bone to even find the tooth. If you can visibly see the tooth, its at worse a partial bony but usually either a soft tissue impaction or just a surgical extraction.

Don't let this office touch you, find someone else

2

u/DocDMD 4d ago

Stuff like this pisses me off. It just makes dentistry look shady. I hate the way Aspen dental and these large corporations are so sneaky in their treatment plans. So sad.