Some general practitioners and many if not most oral surgeons have institutionalized overcharging by routinely classifying extractions as more complex than they actually are.
Many oral surgeons also administer a general anesthetic or I-V sedation as a matter of routine, often at a cost greater than the extraction, even though a local anesthetic injection, often referred to as a shot of novocaine, is adequate and safer.
Uninformed patients have no way of knowing if they are being overcharged, and most insurance companies and public agencies are indifferent to the abuse.
One study by a dental insurance administrator revealed that 62 percent of claim statements (bills) submitted for insurance payments by oral surgeons in California contained overcharges.
In nearly 50 percent of extractions, the oral surgeons claimed that the surgery to remove the teeth was more complex and should be paid at a higher fee than was justified by the actual procedure.
Analysis of bills submitted to Blue Shield of Pennsylvania, one of the largest insurance companies in the country, revealed the same overclassification and overcharging for extractions.
Although these studies were done a number of years ago, dental consultants reviewing billings, have observed the same pattern up to the present.
Four normally developing third molars.
If these four unerupted wisdom teeth are removed, and the two upper ones are charged as full bony impactions, even though they are simple soft tissue extractions, you or your insurance will be
overcharged by as much as $350.
Most of these teeth will erupt normally, at which time the extraction, if needed, would–or should–be charged as a routine, complicated procedure at a cost of approximately $90 each.
Extracting them prematurely with the additional expense of general anesthesia at $175 or more means that the overcharge is even greater than described.
By any standard other than the profession’s and the insurance companies’ acquiescence, this type of
institutionalized overcharging would be classified as fraud.
Source by K.M. Dodd
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