Unbelievable Billing dispute post surgery

[newone08]

Home Florida:
I live in Florida. 2 months ago I had major oral/jaw surgery in Phoenix Arizona because the oral surgeon was highly recommended and I was able to recover around close friends. I paid for the procedure(22k) and all other expenses out of pocket before surgery. Immediately after surgery, while at the recovery center, I was told by my surgeon that the surgery took a little longer than he anticipated because he removed my existing left cheek implant to complete his oral work. He said this took him approximately 20 minutes longer than he anticipated and that I might experience residual swelling as a result. I was surprised but we did not discuss it further. I had 3 post op visits with him in the 6 weeks following surgery.
Here is where it gets interesting...Approximately 3 weeks ago(a month a half after surgery) I receive a letter in the mail for a bill of $2,400. His office has decided to bill me for "cheek implant surgery." I was stunned. The implant already existed and he is not a cosmetic surgeon. I don't understand why this was not mentioned to me during any of the 3 post op. visits. I definitely want to do the right thing and do not want to harm my credit. However this does not seem right. What should I do? What is the procedure for an out of state dispute of medical expenses? How to I address this? Does he have the right to do this?

thank you.

[Zigner]

How many times are you going to ask the same question?

[newone08]

I was not sure which forum to post this question in. It could fall under several categories. Thank you

[Zigner]

Originally Posted by newone08

I was not sure which forum to post this question in. It could fall under several categories. Thank you

Please delete all but one. It is considered bad form to post the same question multiple times. Thank you.

[Clt747]

Originally Posted by Zigner

Please delete all but one. It is considered bad form to post the same question multiple times. Thank you.

I already did that.

[Zigner]

Thank you C -

Now - OP. Your dentist had to do additional, unanticipated procedure. You need to pay him.

[ecmst12]

What you REALLY need to do is call your insurance and advise them that it was not cosmetic surgery and find out what needs to be done so that it will be covered by them. They may need the doctor to resubmit with a different code. It is possible that it's not going to be covered no matter what because the ORIGINAL implant was cosmetic, but it's worth asking your insurance company about this.

The doctor's office is definitely not wrong to bill you for a procedure they did in fact perform and was necessary to complete the procedure you came in for.

[Zigner]

Originally Posted by ecmst12

What you REALLY need to do is call your insurance and advise them that it was not cosmetic surgery and find out what needs to be done so that it will be covered by them. They may need the doctor to resubmit with a different code. It is possible that it's not going to be covered no matter what because the ORIGINAL implant was cosmetic, but it's worth asking your insurance company about this.

The doctor's office is definitely not wrong to bill you for a procedure they did in fact perform and was necessary to complete the procedure you came in for.

Reread the OP.
This is not an insurance question.
The oral surgeon had to perform an extra, unanticipated procedure and now deserves to be paid for it.

[ecmst12]

I answered that part too.

[lya]

Well, I'm not so sure about the answer. It is not unusual for one surgical procedure to lead to another procedure, such as moving an organ or another internal "part" in order to complete the original surgery. I'm not used to seeing an additional charge for the additional procedure, which was necessary to complete the original objective.

Even though the poster did not ask about insurance and if insurance is part of the equation, I quite agree with the reply that advocates contacting the insurance company and the billing department to make sure that the code does not reflect a cosmetic procedure but is coded as being part of the original procedure. (There is a code prefix for the cheek implant that will indicate it was not for cosmetic purposes, that it is the result of X procedure.)

If this is private pay only, I think 22K is more than sufficient. The oral surgeon knew or should have known that the cheek implant could have to be manipulated and should have taken it into account when computing the anticipated costs of the surgery.

newone08 should review his/her pre-surgical anticipated costs to see if any reference to cheek implant manipulation is included in the breakdown of anticipated costs.

I'd actually like Barry to answer from a dental biling perspective.

[barry1817]

Originally Posted by newone08

Home Florida:
I live in Florida. 2 months ago I had major oral/jaw surgery in Phoenix Arizona because the oral surgeon was highly recommended and I was able to recover around close friends. I paid for the procedure(22k) and all other expenses out of pocket before surgery. Immediately after surgery, while at the recovery center, I was told by my surgeon that the surgery took a little longer than he anticipated because he removed my existing left cheek implant to complete his oral work. He said this took him approximately 20 minutes longer than he anticipated and that I might experience residual swelling as a result. I was surprised but we did not discuss it further. I had 3 post op visits with him in the 6 weeks following surgery.
Here is where it gets interesting...Approximately 3 weeks ago(a month a half after surgery) I receive a letter in the mail for a bill of $2,400. His office has decided to bill me for "cheek implant surgery." I was stunned. The implant already existed and he is not a cosmetic surgeon. I don't understand why this was not mentioned to me during any of the 3 post op. visits. I definitely want to do the right thing and do not want to harm my credit. However this does not seem right. What should I do? What is the procedure for an out of state dispute of medical expenses? How to I address this? Does he have the right to do this?

thank you.

for what he said was an extra 20 minutes of his time he wants an additonal $2400. That is $7200/hour, on a 40 hour work week that is $288,000/week, or a billing rate of $14,000,000 a year. Seems a little high, but this is just for financial interest and has nothing to do with your question.

I am basing the follow on what you have stated, and I have not seen what your informed consent stated as to treatment proposed, which might alter the response.

What cheek implant surgery was done? If this is billing for something that wasn't done it is considered billing fraud. Removing an implant to gain access for the treatment and replacing it after the treatment is not doing an implant. It is part of the treatment that you consented to.

Because of billing codes, a dentist/oral surgeon doesn't get two bites at the apple when it comes to billing. And you can bet your bottom dollar that he isn't giving back any money to patients when treatment went quicker than he estimated.

If this were to happen to a family member I would be defending them when they write that the bill is outrageous, and that it isn't going to be paid, but rather that a complaint with the state board will be filed about the billing procedures and if I were writing this letter I would be including in the complaint the allegation of potential billing fraud.

If he did do a cheek implant, and it wasn't part of the informed consent for treatment, some people gone so far as to take a tactic that treatment without an informed consent can be called an assault. That changes this from a billing matter to something much more serious.