MA dental claims

[Chazm]

I am no dental plan expert but that is what i thought how a typical dental plan would cover code 2740 .I asked my dentist office about this since i am in the process of getting a replacement crown due to decay and they confirmed code 2740 is not usually covered by insurance unless there is decay. I hope that the UHC bucket of money dental benefits is covering this but i can't find anything about dental codes foe 2023

I believe these dentist do not want to do a preauthorization before replacing a crown because they fear losing the business once the patient is told it won't be covered or even if it is covered they fear patients will lose interest in treatment plan if they have to wait 3 weeks.

If it’s for 2023, they shouldn’t have to worry about it. I would never guarantee benefits but they repeat over and over that they don’t cover cosmetic. A crown isn’t costmetic. They should be fine. Calling uhc is a waste. Call your local broker manager

 

[LostDollar]

A crown isn’t costmetic.

That is not necessarily true - per UHC standalone dental policy information.

 

[Chazm]

That is not necessarily true - per UHC standalone dental policy information.

Who's talking about a standalone policy?
They will cover a crown in his instance in 2023. I guess if it's totally not necessary, who would cover it?

"Your UnitedHealthcare Routine Dental Benefit provides coverage for preventive and other necessary dental services such as:
o Exams
o Cleanings (Prophylaxis, Periodontal Maintenance, & Deep Cleanings)
o Fillings
o Crowns
o Bridges
o Root Canals
o Partial Dentures
o Complete Dentures
o Implants

• Procedures used for cosmetic-only reasons (tooth bleaching/whitening, veneers, gingival recontouring), orthodontics, space maintenance, sales tax, charges for failure to keep appointments, dental case management, dental charges related to COVID screening, testing and vaccination, and unspecified procedures by report are not covered by the plan. After the annual maximum is exhausted, any remaining charges are your responsibility. Other limitations and exclusions are listed below. "

 

[LostDollar]

I have a few calls recently from disgruntled UHC MA members being denied claims for crowns. The dental code for crowns the dentist are using is a covered dental code but only if there is sign of decay. These dentist are recommending crown replacements for worn or chipped crowns with no sign of decay ,

• Procedures used for cosmetic-only reasons (tooth bleaching/whitening, veneers, gingival recontouring), orthodontics, space maintenance, sales tax, charges for failure to keep appointments, dental case management, dental charges related to COVID screening, testing and vaccination, and unspecified procedures by report are not covered by the plan. After the annual maximum is exhausted, any remaining charges are your responsibility. Other limitations and exclusions are listed below. "

There you go. That's why op's clients are having trouble. Clients need to insist on pre-determinations prior to treatments or dentists need to submit the claims differently.

 

[LostDollar]

Is this common with dental plans in general?

(and for his background information, OP also asked about dental plans in general, in addition to UHC specific MAPD.)

 

[Chazm]

There you go. That's why op's clients are having trouble. Clients need to insist on pre-determinations prior to treatments or dentists need to submit the claims differently.

Or…like has been mentioned a few times, he’s referring to 2022. When they only covered certain procedures.

 

[somarco]

It is virtually impossible for a dentist to know if there is decay under the crown until the crown is removed. X-rays do not show what is under the crown.

 

[LostDollar]

Yeah, in 2022 they only covered certain services.

Or…like has been mentioned a few times, he’s referring to 2022. When they only covered certain procedures.

(Caveat, not an agent)

I think you have allowed yourself to be snookered by an opinion you formed based on perspective.

For a short period of time in 2021 I had 3 individual dental insurance policies.

A UHC product comparable to one of 6-8 current under 65 products

A BCBSKS product, the top one of 2 products geared to the senior market

A Delta Dental KS product, the third highest of 4 individual products

Each one of my 3 policies

"... only covered certain services."

and they also

"... provide[d] coverage for preventive and other necessary dental services such as:
o Exams
o Cleanings (Prophylaxis, Periodontal Maintenance, & Deep Cleanings)
o Fillings
o Crowns
o Bridges
o Root Canals
o Partial Dentures
o Complete Dentures
o Implants

Presenting a dental insurance product in year A with a list of covered procedures and in year B with a list of categories of dental services covered does not necessarily mean the underlying dental insurance product has changed.

It was just marketed to consumers in year A with a presentation that could be construed as exclusive. It was then marketed to consumers in year B with a presentation that could be construed as inclusive.

I think it is likely that the UHC MAPD dental product was basically the same in 2022 and 2023, just presented differently.

 

[alphawave2k]

It is virtually impossible for a dentist to know if there is decay under the crown until the crown is removed. X-rays do not show what is under the crown.

Very true. I just had a crown removed (destroyed in the process) over a molar that had a root-canal to find out why I was feeling some "discomfort" after 2 years. Took advantage while in South America to have the whole process done (re-examined root canal, and replaced with a porcelain crown vs metal one for <$500). The original root canal and crown cost me $2300 in the US with the Humana Dental Value C 550, and it was not done correctly it seems. I don't think this type of plan discounted anything for either of those procedures, plus it's an HMO to boot. It works fine for regular x-rays and cleanings, and maybe just an occasional filling.

 

[LostDollar]

I don't know about seeing decay under a crown with xrays, but two dentists and an endodontist are showing me xrays that show the root canals under crowns, and telling me that there is no problem with the root canals.

I have angered the endodontist and been "fired" by both dentists because I won't sign up for 30-45 minute drives (one way) across town to consult a tmj specialist they want me to see. (They give absolutely no consideration to my concern that the lifespans of everyone on the high speed town roadways (including mine) are diminished when I would be making that drive.) There were sparks coming out of the second dentist's eyes when I happened to drop the term "quack dentistry" in regard to tmj treatment.