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It has been a month since the episode of my emergency root canal procedure in May. While I am still waiting for the crown to be done in July, I have received the bills from all of my three dentists involved in the care, as well as the EOB (explanation of benefits) from my insurer. Now, it's time to look at the total cost.
Dr. Yang filed a total of $135 claim that consisted two line item:
(1). ADA CODE D0140, limited oral evaluation - problem F, for $100
(2). ADA Code D0220, intraoral-periapical-first F, for $35.
I was surprised to see that my insurer paid Dr. Yang claim it in full since he is an out-of-network provider network.
Dr. Ebeid, an in-network provider, filed a total of $1,503 claim that consisted of three line items:
(1). ADA Code D0220, intraoral-periapical-first F, for $45. The insurance allowable amount for this procedure is $21. My insurer paid it in full without any out-of-pocket payment from me.
(2). ADA Code D9310, consultation (diagnostic service), for $162. The insurance allowable amount for this procedure is $118. My insurer paid 80% of it for $94.40, and I have a coinsurance payment of 20% for $23.60.
(3). ADA Code D3330, root canal therapy - molar (excluding final restoration), for $1,296. The insurance allowable amount is $980. My insurer paid 80% of it for $784, and I have 20% of coinsurance payment for $196.
Dr. Ebeid received a total of $1,119 for his service. My insurer paid $899.40 and my out-of-pocket expense was $219.60.
Dr. Gamboa submitted a pre-authorization of ADA Code D2750 for a crown with a cost of $1,112 for final restoration in July. the insurance allowable amount for this procedure is $746. My insurer will pay 50% of it for $373, and I am responsible for the other 50%. I pray that there won't be any surprises when I go for the crown in July.
The total tab of this dental care is $2,000, out of it my insurance picked up $1,407.40 and I paid $592.60.
Life is fragile and human body is unpredictable, regardless how diligent I am in taking care of myself, emergency does happen. I am fortunate to have dental coverage and am able to pay my share of the cost. With the cost of health care sky rocketing, I wonder how many people who can't get the treatments when they need it? what can be done?
Friday, June 27, 2008
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Hey! Thank you for the comment on my blog. Isn't it fun learning how to create the codes for our blogs. A least I'm having fun with it... that is when I have the time to sit down at the computer to write a blog post lol
ReplyDeleteOh I had a dental emergency about a two years ago. Ended up with a root canal and a crown costing me over $700 even though I thought I had great dental insurance. OUCH.
Something really does need to be done. It's outrageous how much money Americans end up spending on health care. I'm thankful we do have health insurance. I don't know what we would do if we didn't.
Dear Eunice,
ReplyDeleteThanks for the detailed information of charge that a root canal treatment is required.
It seems to me that the American way of healthcare insurance is probably the highest among OECD countries. One scholar attributes the major reason to the profit-making as contrast to that of Taiwan, where the core value of healthcare should be non-profit and promoting people's health.
I am still thinking whether this comment is right.
JD from Hoping, Taiwan
Thanks,JD,for the comments.
ReplyDeleteThe high cost of health care in this country has been a very contentious issue in both the public and the private sectors. There are too many variables that cause this problem, and human greed is probably one of them. There is no easy way out, nevertheless, many people are working hard to change it, my current company is one of them.
Eunice
cool
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