HELP W CANADIAN DENTAL ASSOCIATION FEE GUIDE!!

Message

#1 Post by **Laundraholic** » Thu Oct 07, 2010 6:52 am

I've got double-jaw surgery scheduled for an underbite in March 2010.
The oral surgeon's office has sent a treatment estimate to the insurace company. I have EXCELLENT insurance coverage, but it's come back that of the codes no longer exists in the 2010 Ontario General Practitioner Dental Association Fee Guide.
My insurance will basically pay 100% up to the amount recommended in the guide. One of the codes is for treatment planning -- the office is charging $1650 and the suggested fee in the guide is $60.37... so the insurance company will only pay the $60.37.

HELP!!

Does anyone in Ontario have the codes they used?

Since I'm in Ontario the actual surgery and hospital stay and everything is covered, but its a $3500 charge for the "surgeon's fee", which I guess just covers treatment planning and other small stuff.
As it stands, out of the $3500 submitted to the insurance company, only $348.96 is covered.

#2 Post by **Hyrule** » Fri Oct 08, 2010 3:24 am

I'm canadian as well and that kind of surgery is indeed costly ( well to our point of view it is but from others it's not ) I was also advised that it would cost around 2k. As you said the fist 2k is surgeon's fee and in any cases they wont be covered by insurance policy. To my knowledge there isnt any policy that is covering that. I'm in quebec so the governement is paying for that surgery but not for the fees and my dental plan doesnt cover any of that.

#3 Post by **kmputnam** » Wed Oct 13, 2010 2:33 pm

Unfortunately it also seems to depend which province you are in. In BC, MSP only covers the hospital costs and I have to pay the surgeon's fees which are over 10K. (For both upper and lower jaw)

#4 Post by **Laundraholic** » Thu Oct 14, 2010 5:47 am

I understand that what your provincial health care (in my case OHIP) covers varies from province to province.

Here the entire actual surgery is covered, so I'm only out-of-pocket the "surgeon's fee", which seems to be the additional fee the surgeon requests to cover stuff like treatment planning and post-surgery care.

However, I have REALLY REALLY EXCELLENT health benefits from my employer, and I was hoping that the out-of-pocket amount would be covered by that (or at least 50%, as my braces were).

And my employee benefits DO seem to cover things 100% up to the maximum suggested but the Ontario Dental Fee Guide... the trick is finding what codes to use.

The oral surgeon's office has thankfully said they'll review the codes they used -- they said that the codes are so vague that they just use general codes usually.