Did I actually get a deep-cleaning?

Discussion in 'Dental Archive' started by Patient, Aug 22, 2006.

  1. Patient

    Patient Guest

    I had a dental appointment a few weeks ago - oral examination, X-rays and a
    cleaning procedure. The entire cleaning procedure took about 20-25 min max.
    When after the procedure I asked the dentist whether I needed deep-cleaning
    he (looking slightly embarrassed) said that deep-cleaning is what I just

    Today I got an invoice from my dental insurance:

    The actual cleaning procedure:
    7/4 - took 20 minutes

    Perio Scaling UL 07/04 $188
    Perio Scaling UR 07/04 $188
    Perio Scaling LR 07/11 $188
    Perio Scaling LL 07/11 $188

    I did have an unrelated filling appointment on 7/11 and I am 100% positive
    there was no cleaning involved.

    I don't have to pay anything, The insurance covered it but the charges maxed
    out my annual benefits amount. Anyway is it realistic to get a deep cleaning
    procedure during one 20-25 minute session without even knowing about it? And
    if not what should I do about the situation.

    Patient, Aug 22, 2006
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  2. Patient wrote:
    Truth is, generally with participating dental plans, dentists will bill
    for periodontal codes inappropriately. You would have to be bionic to
    do a real deep cleaning in 4 quadrants in 20 minutes, but we've heard of
    patients getting it done in 10 minutes!
    Many insurance companies are cracking down on this practice, but in the
    plans with low annual maximum benefits they frequently look the other
    way. Many plans will however at least ask for a detailed periodontal
    charting to justify using the periodontal codes.
    In any case, it's unlikely IMO that the insurance company will
    investigate further unless you file a complaint.
    Everything Dr. Abu said is correct. Look at your explanation of
    benefits carefully--was the dentist actually REIMBURSED $188 per
    quadrant? Or was this the dentist's charge, and was he actually
    reimbursed at a far lower rate?
    BTW, it is not always clear whether a dentist is "waiving copayment" or
    not. I participate in plans that advise me to enter my regular fee,
    which the insurance company will then reduce to the maximum allowable
    fee under the contract.

    Mark & Steven Bornfeld, Aug 22, 2006
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