peteysweetusername t1_j5u61jj wrote
I get four per year and have had insurance with both delta and blue cross. Because I had scaling done a few years ago the 4x per year was covered. Not sure if that’s the case with you but I can find out more if that sounds familiar
makeupobsessedlawyer t1_j5v21eg wrote
Work in a dental office. After an SRP, scaling and root planing or also known as a deep cleaning, most patients are placed on a 3 month periodontal maintenance. That is seen as a different under insurance frequencies than a regular prophy which is only 2 times per year usually.
peteysweetusername t1_j5v7cyl wrote
This is the answer. His/her office probably doesn’t know how to code it
[deleted] t1_j5v8elv wrote
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peteysweetusername t1_j5valc5 wrote
Are you saying I have two insurances?
[deleted] t1_j5vd3l6 wrote
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Sardoniosophy t1_j5utfmb wrote
I have been with Delta, and they covered mine when I needed cleanings 4x a year. It came down to how the dental office coded the visits. As it was mandated by my dentist, I had no issues.
makeupobsessedlawyer t1_j5v2ji9 wrote
I work in a dental office. Has nothing to do with how offices “code” things. I’m so tired of patients thinking it’s the fault of the office because things get denied sometimes. The exact codes are billed on the date of service the services are rendered, there is no trick or sneaky thing offices do to get cleanings covered 4 times a year for patients. It has to do with your plan’s frequency limitations. Some plans allow 4 cleanings a year, like yours.
Sardoniosophy t1_j5v3eur wrote
While I don't work in a dental office and I know certain insurance plans have a limitation on how many of something or what is covered, I have also been explicitly told both by my service providers, i.e. the dental or doctor's office, and my insurance that applying the right/correct code makes a difference in coverage. I could be being gaslit by both sides, but I'm just sharing what my experience has been and what I have been told. 🤷♀️
yahabbibi t1_j5wmde2 wrote
The other commenter who works in dental billing is correct. There are frequency limitations on codes and a basic dental hygiene cleaning has only two codes for a basic prophy which is hand scaling and polishing: one code or adult patients (14 and up) and one for pediatric. A hygiene exam (w Dentist) is a separate code, fluoride is another. If your plan only covers 2 prophys per year (either 2x calendar yr or 2 6mo apart) and you're getting 4 for free your dental office is committing fraud by coding 2 of them as something else you have coverage for to get the insurance money. Root scaling? You'll need to look at your coverage and benefits and check the EOBs your carrier sends you after each service. If you only have 2 included in your plan and go 4 times for the dame service it should be coded exactly the same for all 4 visits. Fact.
aleshere OP t1_j5u6w05 wrote
I had that recommended but haven't done yet.
Will discuss with my dentist, it seems the best way forward hopefully he can help.
peteysweetusername t1_j5ui353 wrote
If you need scaling get it done asap. If your dentist is recommending it with cleanings 4x per year your gum recession is likely bad. A scaling will get the gunk that’s accumulating underneath the gum line and will improve your mouth hygiene. It will also qualify you for four free cleanings per year
makeupobsessedlawyer t1_j5v2poc wrote
Not necessarily true. Some plans only cover 2, the other 2 will need to be paid out of pocket. Doesn’t automatically qualify you. Check with your insurance and dental office.
peteysweetusername t1_j5v7lga wrote
As others have said on this post you don’t get “cleanings” after periodontal work you get perio maintenance which is covered every three months
[deleted] t1_j5v7see wrote
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