We have a diabetic patient that had an infection in #3 and the tooth was previously root canal-ed. We extracted and placed bone graft and membrane. Since patient is diabetic we chose to wait to place the implant until we knew she was healing properly. Patient asked us to send all of this to her medical insurance. As I have never billed medical I feel out of my league. So a few questions Do I need to wait until the implant is placed to bill to medical? or can I bill now for the extraction and bone graft. Her insurance gave me the codes we were to use for all of the procedures and said no pre-auth was required and that she had out of network benefits. I was told all of the procedures are covered at 80% after her $500 deductible was met and her out of pocket max is $1200. Does this mean that after she pays $1200 she will not have a copay? I was also told the implant is not broken up into three parts when billing medical. Is this correct? They said that I would need to provide the diagnostic codes. Would the diabetes be one of those? Thank you so much for the help! My doctor said if cases like this can be billed to medical with success he wants to send me to a course so that we can offer this to patients. I honestly have about 30 patients now that could benefit from this so i”m hoping this is a success.
