Imagn Billing Feature Case: Bone Graft, Barrier & Excision of Bone
- Case Type: Bone Graft, Barrier, Excision of Bone
- State: Washington
- Insurance Payer: Premera Blue Cross
- Insurance Paid: $2,245.54
In this example Imagn Billing case you will see how a dental office in Washington successfully billed for bone-grafting, barrier, bone excision with biopsy, and complex incision repair. Our Imagn Billing team processed this claim on 08/5/2020 to Premera insurance the claim was denied, and our team filed the appeal on 10/19/2020 and it was paid on 10/31/2020.
The 40-year-old male patient presented for an emergency appointment with symptoms of jaw pain. Radiographs showed radiolucency surrounding tooth 29-30 with moderate mandible atrophy. Also noted, a .3 cm cyst encompassing 29-31 area.
Proving Medical Necessity
As noted in the provider’s SOAP note:
- Medical Indication for removal of 29-30:
- Severe mandible atrophy caused by .3 cm cyst.
- Medical Indication for BG: Prepare site for future implant placement, maintain healthy bone level to support existing dentition.
- Medical Indications for Membrane: protect bone graft and allow bone to mature uninterrupted.
Billing Medical Insurance
The practice collected all required documentation and clinical SOAP notes. After completing the verification of benefits, it was determined that coverage was available after the deductible is satisfied. Pre-Authorization was required and was completed with approval along with a Gap exception.
- Allowable: $2,645.54
- Total Collected From Patient & Insurance: $2,645.54
- Applied to Deductible: $1,500
- Patient Portion: $1,145.54
Dental Comparison
Without medical insurance contribution, the practice would be writing off approximately 29% and using of the annual $1000.00 maximum. Medical insurance saved the patient and the practice approximately $1500, whereas dental insurance would be exhausted. The patient also completely satisfied their deductible, so moving forward they will have less out of pocket expenses if a healthcare issue arises.
Ms. Owens,
I’ve contacted you before. I’m a dentist in the San Francisco Bay area and I’ve taken a medical billing course 1 time prior. the staff found the process too daunting, confused by whether deductibles would interfere with billing, and overall, found the original course interesting, but not enough information or casework was given to the point they were ready to start the process.
I know you have a course in Dec in Orem and that the last time I looked, many of your courses were there.
Questions:
Is your online course cover much of what you cover in person?
Do you have planned courses to be offered in Northern California?
If not, could I help arrange for a course in Northern California, and how many attendees would be needed and what would the cost structure look like?
Since my staff has already had a first dip into this subject, they need a refresher for one thing. However, mostly, they would feel more comfortable if there were lots of sample cases where they could work up so they feel more comfortable upon office return, to start the process.
I would love to talk to you regarding the above.