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Good Afternoon! I have a different type of question. I have a patient who we filed her Medical Plan for a Frenectomy (CPT: 41010) procedure and it went towards her deductible resulting in an out of pocket cost. She is asking us now to bill her dental (D7960) and the patient is under the impression that whatever dental insurance pays will take care of her balance from her medical deductible. I was taught this was not the case because there is no coordination of benefits between a medical policy and dental policy. Do you have any insight on this? I have tried researching this topic and I am having a hard time finding where it concretely states this. On the ADA's website I found where it talked about dental embedded benefits, but this is not our case. I learned that in this situation the patient owes deductible/co-ins from medical and then also whatever the dental ins deductible/co-ins is as well since there is no coordination between the two. Or this is a case by case basis? I am obviously trying to protect my doctor especially if he was ever to get audited. Please help! Edited by user Thursday, July 23, 2020 1:36:02 PM(UTC)
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Hi Liz!
Great question. In a situation where there are both medical and dental benefits available for a service (this happens in TMJ disorders diagnosis & treatment services as well, for example), you can certainly bill both medical and dental, however as you mentioned, it is not a situation where the dental insurer will end up covering the medical insurer's deductible or anything like that - the patient is still responsible for deductible & coinsurance from their medical plan.
Basically, once the EOB is received from medical, you can then bill it to dental after that, but you would include a copy of the EOB from medical so the dental insurer will see what has already been processed/paid, much like filing any secondary claim. Depending on how much was allowed/paid by medical, and depending on if the dental insurer deems the services dental in nature and covered, there may or may not be any additional reimbursement on the claim.
Hope this helps!
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Rank: Guest
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