• filter:
  • Page :
  • 1
  • Text Only
  • Search this Topic »
Voting History
rated:
I went to a hospital-based Specialized Dentist.  I gave them my Medicare insurance info.  They asked me whether I have any other insurance; and I said no.  They didn't ask me to sign anything guarantying payments. 

I need to have 2 front teeth extracted and had to wait for the effects of my medication to wear off.  The dentist told me that they can have a temporary denture ready so that they can be put on until the bone healed and a permanent denture will be made. 

I see my office visits to that Dentist was processed through Medicare; and it paid.  So I expect them to tell me if anything they do is not covered by Medicare and how much it would cost.  They didn't do that and I got a bill for the extraction ($630) and the temporary denture ($2520).  My regular dentist told me that he would have charged $1K for the denture (and basically the same amt for the extraction).

Are Medicare healthcare providers required to provide me with an ABN.  If they are, that give me the leverage to get them to accept $1K (+their bill amount for extraction).  If they are not required to do so, I would appreciate any advice on how to deal with the matter.

P.S.  Medicare paid the specialized dentist just under 23% of what they billed.  Also, if I had known the cost of the temporary denture, I would just skip that part and go without it for a few months and then get the permanent denture.

TIA

 

Member Summary
fat9wallet said:   I went to a hospital-based Specialized Dentist.  I gave them my Medicare insurance info.  They asked me whether I have any other insurance; and I said no.  They didn't ask me to sign anything guarantying payments. 

I need to have 2 front teeth extracted and had to wait for the effects of my medication to wear off.  The dentist told me that they can have a temporary denture ready so that they can be put on until the bone healed and a permanent denture will be made. 

I see my office visits to that Dentist was processed through Medicare; and it paid.  So I expect them to tell me if anything they do is not covered by Medicare and how much it would cost.  They didn't do that and I got a bill for the extraction ($630) and the temporary denture ($2520).  My regular dentist told me that he would have charged $1K for the denture (and basically the same amt for the extraction).

Are Medicare healthcare providers required to provide me with an ABN.  If they are, that give me the leverage to get them to accept $1K (+their bill amount for extraction).  If they are not required to do so, I would appreciate any advice on how to deal with the matter.

P.S.  Medicare paid the specialized dentist just under 23% of what they billed.  Also, if I had known the cost of the temporary denture, I would just skip that part and go without it for a few months and then get the permanent denture.

TIA
Staff Summary
Thanks for visiting FatWallet.com. Join for free to remove this ad.

rated:
https://www.medicare.gov/coverage/dental-services.html

Generally, Medicare does not, and has not, covered dental care. You need to have a supplemental plan for dental coverage. The Part A coverage is for surgical procedures in a hospital, not routine dental care. Extractions and dentures are routine, and not covered by Medicare. They aren't required to give you an ABN for non-covered services.


"If you have Original Medicare and your doctor, other health care provider, or supplier thinks Medicare probably (or certainly) won't pay for items or services, they may give you a written notice called an "Advance Beneficiary Notice of Noncoverage" (ABN). However, an ABN isn't required for items or services that Medicare never covers."

https://www.medicare.gov/claims-and-appeals/medicare-rights/abn/...

rated:
In general, if you are a known Medicaid patient, you must be notified in writing that something will not be covered, or the provider must eat the cost of anything Medicaid declines.  I don't know if there's a similar rule for Medicare, but it's worth looking into.

What was the circumstances of the extractions, and being at a hospital-based dentist?  Was it due to something medical, like being hit in the face with a baseball?  It's unclear why they'd cover the office visits, but not the procedure?

rated:
fat9wallet said:   I went to a hospital-based Specialized Dentist.
...
My regular dentist told me that he would have charged $1K for the denture (and basically the same amt for the extraction).

So you devised a strategy to get the extraction(which you already knew is not covered by MediCare) done for free and are surprised that it and other dental procedures were not covered ?

rated:
xoneinax said:   
fat9wallet said:   I went to a hospital-based Specialized Dentist.
...
My regular dentist told me that he would have charged $1K for the denture (and basically the same amt for the extraction).

So you devised a strategy to get the extraction(which you already knew is not covered by MediCare) done for free and are surprised that it and other dental procedures were not covered ?

No.  As I said -- because I see the office visits were billed to Medicare and it was paid --  I thought that Medicare healthcare providers would tell me when something is not covered and how much it would cost so that I can decide whether I want it done.  [Another hospital did that for their medical services.]  It is *only after* I got the bill that I knew that Medicare doesn't cover the denture.  And after the fact, I asked my regular dentist what it would normally cost to get an idea how to settle this bill.

Most fatwallers don't have devious minds.
 

rated:
Then what was your motivation to specifically choose and use a Hospital dentist rather than simply going to your regular dentist ?
It sounds like you were hoping your dental procedure would become a MediCare covered "medical" procedure by having it done inside a hospital ?

rated:
Glitch99 said:   In general, if you are a known Medicaid patient, you must be notified in writing that something will not be covered, or the provider must eat the cost of anything Medicaid declines.  I don't know if there's a similar rule for Medicare, but it's worth looking into.

What was the circumstances of the extractions, and being at a hospital-based dentist?  Was it due to something medical, like being hit in the face with a baseball?  It's unclear why they'd cover the office visits, but not the procedure?

  
Medicaid and Medicare, are two very different programs. In fact, even within Medicaid and Medicare, depending on if you have traditional or you have a PPO or HMO, rules can vary, as you are subject to additional ones from the managed care provider, in addition to Medicaid/Medicare rules (like being restricted to in-network doctors & hospitals). As I stated in my above post, Medicare does not require an ABN, providers may give one if there are concerns that Medicare won't pay, and they don't have to give anything for non-covered services. Since Medicare has no coverage for routine dental services, there is no obligation for the provider to issue an ABN. The patient is responsible for any non-covered charges under Medicare, not the provider.

Unlike Medicaid, Medicare has premiums, co-pays and deductibles that the patient is responsible for. Some Medicaid services have a low co-pay. Traditional Medicare patients must pay-in-full until their deductible is met, and then they still have to pay the co-pay for covered services. Those with Medigap policies may have different deductibles and co-pays, some covered services may have none. Dual-eligibles (both Medicare and Medicaid in the form of a Medicare Savings Plan), may have reduced or none. If a provider orders a procedure/test that Medicare covers only when certain conditions are met, Medicare may cover it as a one-time courtesy (if an order to another provider) to the patient. If a provider bills a non-covered procedure/test to Medicare, that the provider should have known that the patient doesn't meet criteria for, the provider cannot bill the patient, they must absorb the cost. The patient is responsible for a service that Medicare has never provided, whether an ABN was issued or not.

rated:
xoneinax said:   Then what was your motivation to specifically choose and use a Hospital dentist rather than simply going to your regular dentist ?
It sounds like you were hoping your dental procedure would become a MediCare covered "medical" procedure by having it done inside a hospital ?

Anyone with an average intelligence can think of a regular reason for visiting a specialized dentist.  And I never said the services were provided inside the hospital.

Your responses indicate you don't know the basics of Medicare; you don't read the OP carefully and you have too much time on your hand.  Why not use that time more productively -- like reading up on the topic before you respond or do some volunteer work?

   

rated:
fat9wallet said:   
xoneinax said:   Then what was your motivation to specifically choose and use a Hospital dentist rather than simply going to your regular dentist ?
It sounds like you were hoping your dental procedure would become a MediCare covered "medical" procedure by having it done inside a hospital ?

Anyone with an average intelligence can think of a regular reason for visiting a specialized dentist.  And I never said the services were provided inside the hospital.

Your responses indicate you don't know the basics of Medicare; you don't read the OP carefully and you have too much time on your hand.  Why not use that time more productively -- like reading up on the topic before you respond or do some volunteer work?

   

 "...I never said the services were provided inside the hospital..." "...I went to a hospital-based Specialized Dentist..."
Please "read the OP carefully".

rated:
fat9wallet said:   
xoneinax said:   Then what was your motivation to specifically choose and use a Hospital dentist rather than simply going to your regular dentist ?
It sounds like you were hoping your dental procedure would become a MediCare covered "medical" procedure by having it done inside a hospital ?

Anyone with an average intelligence can think of a regular reason for visiting a specialized dentist.  And I never said the services were provided inside the hospital.

What was your reason for visiting a hospital-based Specialized dentist for a routine procedure that could have been done by your regular dentist ?

rated:
fat9wallet said:   Your responses indicate you don't know the basics of Medicare; you don't read the OP carefully and you have too much time on your hand.  Why not use that time more productively -- like reading up on the topic before you respond or do some volunteer work
FWF is a community where everyone can learn. Your personal attacks are not helpful in this regard.

rated:
xoneinax said:   
fat9wallet said:   
xoneinax said:   Then what was your motivation to specifically choose and use a Hospital dentist rather than simply going to your regular dentist ?
It sounds like you were hoping your dental procedure would become a MediCare covered "medical" procedure by having it done inside a hospital ?

Anyone with an average intelligence can think of a regular reason for visiting a specialized dentist.  And I never said the services were provided inside the hospital.

What was your reason for visiting a hospital-based Specialized dentist for a routine procedure that could have been done by your regular dentist ?
 

The reason was in my OP.  The denture may be routine; but what started it wasn't.

 

rated:
xoneinax said:   
fat9wallet said:   Your responses indicate you don't know the basics of Medicare; you don't read the OP carefully and you have too much time on your hand.  Why not use that time more productively -- like reading up on the topic before you respond or do some volunteer work
FWF is a community where everyone can learn. Your personal attacks are not helpful in this regard.

You "learn" by implying/accusing people of being devious???

I consider my remarks as observations.  Even if you consider them as attacks; I guess you can Dish it out but can't take it in return??
 

rated:
svap said:   
fat9wallet said:   
xoneinax said:   Then what was your motivation to specifically choose and use a Hospital dentist rather than simply going to your regular dentist ?
It sounds like you were hoping your dental procedure would become a MediCare covered "medical" procedure by having it done inside a hospital ?

Anyone with an average intelligence can think of a regular reason for visiting a specialized dentist.  And I never said the services were provided inside the hospital.

Your responses indicate you don't know the basics of Medicare; you don't read the OP carefully and you have too much time on your hand.  Why not use that time more productively -- like reading up on the topic before you respond or do some volunteer work?

   

 "...I never said the services were provided inside the hospital..." "...I went to a hospital-based Specialized Dentist..."
Please "read the OP carefully".

These doctors also keep office hours outside the hospital.
 

rated:
fat9wallet said:   The reason was in my OP.  The denture may be routine; but what started it wasn't.
Extracting 2 front teeth is routine. Waiting for medication to wear off is routine.  Waiting for the bone to heal is routine.  The denture is routine.

What in your OP is not routine except the particular choice to visit a dentist associated with a hospital and hope MediCare will cover it ?

rated:
fat9wallet said: As I said -- because I see the office visits were billed to Medicare and it was paid --

I'm confused as to why Medicare paid for the office visits, especially because you indicated that you are a traditional Medicare patient, and have no secondary  insurance such as a Medigap with added dental benefits. Did you receive an actual statement from CMS showing payment by Medicare? Those mailings from CMS can arrive 3 - 6 months, and even longer, after a covered service has been submitted. Nothing dental done in an office is covered by Medicare, dental procedures such as necessary Oral and/or Maxillofacial procedures performed in a hospital setting are covered by Part A, procedures performed by a dental surgeon.

Did you have some kind of surgical procedure to prepare the bone for a better fit of your dentures? Does this office have a surgical center? (Medicare Part A may pay for procedures done in an out-patient surgical center)  Office visits are covered by Part B, and Part B doesn't cover dental anything.  But if you actually needed work done on the bone where your teeth were extracted, and it was done in a Medicare compliant outpatient surgical center, Part A may have paid for the bone preparation. It's like eye care with Medicare. Routine eye exams for refractions and corrective lenses plus eye glasses and/or contacts, aren't covered. But screening for retinopathy, glaucoma and macular degeneration, as well as cataract surgery and treatment for retinal or macula damage, are covered. You may have had a covered procedure paid by Medicare Part A (bone prep for denture), but other services done at the same time, are not.

rated:
SweetClover said:   
fat9wallet said: As I said -- because I see the office visits were billed to Medicare and it was paid --

I'm confused as to why Medicare paid for the office visits, especially because you indicated that you are a traditional Medicare patient, and have no secondary  insurance such as a Medigap with added dental benefits. Did you receive an actual statement from CMS showing payment by Medicare? Those mailings from CMS can arrive 3 - 6 months, and even longer, after a covered service has been submitted. Nothing dental done in an office is covered by Medicare, dental procedures such as necessary Oral and/or Maxillofacial procedures performed in a hospital setting are covered by Part A, procedures performed by a dental surgeon.

Did you have some kind of surgical procedure to prepare the bone for a better fit of your dentures? Does this office have a surgical center? (Medicare Part A may pay for procedures done in an out-patient surgical center)  Office visits are covered by Part B, and Part B doesn't cover dental anything.  But if you actually needed work done on the bone where your teeth were extracted, and it was done in a Medicare compliant outpatient surgical center, Part A may have paid for the bone preparation. It's like eye care with Medicare. Routine eye exams for refractions and corrective lenses plus eye glasses and/or contacts, aren't covered. But screening for retinopathy, glaucoma and macular degeneration, as well as cataract surgery and treatment for retinal or macula damage, are covered. You may have had a covered procedure paid by Medicare Part A (bone prep for denture), but other services done at the same time, are not.

I am just as confused.  I started with my regular dentist; but he doesn't even recognize the name of the medication that I was prescribed.  So I thought I should find a dentist that has in-depth knowledge of how the medication can impact on the teeth extraction.

When I first went to the specialized dentist, I was under the general impression that Medicare does not cover dental services.  When then I receive monthly billing statements showing charges incurred, amounts submitted to insurance, etc.  [The monitoring took over 6 mos.]  And I see the dental office visits were submitted to Medicare and were paid.  And I mistakenly thought that providing me with ABNs is required -- because of my previous experience of being presented with ABNs by some healthcare providers.  The combination of those two factors resulted in my "letting my guard down" and I did not ask about the costs.

After I received the bill for the denture, I asked the billing dept why the office visits are covered by Medicare and not the dentures.  I spoke to 2 persons including one supervisor.  They both gave me the same answer -- office visits are dental services; and denture is not.

I did not have any dental surgery.  But these dentists do not take on new patients without referrals.  So I can only guess that since the referral to the dentist was medically related, that would be the reason for Medicare to cover those office visits.
 

  • Quick Reply:  Have something quick to contribute? Just reply below and you're done! hide Quick Reply
     
    Click here for full-featured reply.


Disclaimer: By providing links to other sites, FatWallet.com does not guarantee, approve or endorse the information or products available at these sites, nor does a link indicate any association with or endorsement by the linked site to FatWallet.com.

Thanks for visiting FatWallet.com. Join for free to remove this ad.

While FatWallet makes every effort to post correct information, offers are subject to change without notice.
Some exclusions may apply based upon merchant policies.
© 1999-2016