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Sardoniosophy t1_j5utfmb wrote

Reply to comment by peteysweetusername in Dental Insurance which covers 4 cleaning per year? by aleshere

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.

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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.

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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. 🤷‍♀️

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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.

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