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Reasonable and Customary?

This article was written by in Health. 9 comments.

This coming Friday, I’ll be the happy recipient of oral surgery. My third molars (wisdom teeth) have been slowly creeping towards the surface of my gums for the last ten years, and I’ve decided it’s time to get them yanked. My company’s health plan requires that these expenses are covered by dental insurance rather than medical insurance — usually surgery, even oral surgery, is covered under medical insurance.

Here are the details of the cost me of the operation. The surgeon recommended to me is “out-of-network,” and I’m under the impression I could have saved a lot of money by finding a different surgeon. I do have to pay for the entire procedure up front, and then wait to be reimbursed.

The columns are quantity, billing code, description of charge, the surgeon’s fee, the percentage of the resonable and customary fee covered by my health care provider (Aetna), what Aetna has determined the reasonable and customary fee to be for each procedure (as you can see, the surgeon charges higher than the R&C fee), the total charge for the procedure, the amount of that total which will later be reimbursed to me, and how much I’ll be stuck with in the end.

Updated July 16, 2010 and originally published November 7, 2005. If you enjoyed this article, subscribe to the RSS feed or receive daily emails. Follow @ConsumerismComm on Twitter and visit our Facebook page for more updates.

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About the author

Luke Landes is the founder of Consumerism Commentary. He has been blogging and writing for the internet since 1995 and has been building online communities since 1991. Find out more about Luke Landes and follow him on Twitter. View all articles by .


avatar jim

It’ll cost me $264 to get two teeth removed so it looks like our prices are inline…

avatar Anonymous

I remember getting these when I was 16, I’m glad about that. Any reason why you waited so long?

avatar Luke Landes

Ten years was probably a little bit of an exageration — I only noticed them coming in as I was finishing up undergrad, so maybe it was eight years ago. They’ve never really bothered me until a few months ago, and my dentist wasn’t too concerned about them until my last appointment. His only concern is that the bone hardens with age and getting them extracted when you’re older can be a little more complicated.

avatar fivecentnickel.com

I had five teeth pulled last spring for a grand total (before insurance) of just over $1280. After insurance (once I finally get everything settled — it’s a long story) I’ll end up paying $680. But my dental insurance sucks. Good luck,


avatar Caitlin

$65 “discount” for the partially impacted tooth. It makes sense, just struck me as a little funny. I hope it goes smoothly for you Flexo

avatar California Health Insurance

Dental work can be extremely expensive. Dental insurance is a great product to have for all the dental needs.

avatar savvy saver

I was in high school (16 years old) when it was determined that my wisdom teeth needed to be removed. I didn’t have insurance, but I was lucky enough to work for a dentist who offered to do them for cost. No anesthesia (no insurance, no anesthesiologist), and it took forever. All four were impacted and I had to listen to and feel the chisel. I had pain medication but it was still horrible. The dentist swore when it was over that he would never, ever do wisdom teeth extractions again (and he hasn’t) and I swore that I would forever in my life carry dental insurance.

have fun!

avatar savvy saver

Also, some advice from someone who used to work in a dental office… follow all the instructions they give you! No straws, no smoking, take your pain meds and the anti-inflamatories. Wisdom teeth removals can be a bitch if they don’t heal right the first time. If you let them get infected or get dry sockets it can take much, much longer to heal.

avatar Cap

wow.. whats up with everyone getting their wisdom teeth pulled lately.

mine’s sorta coming out too.. do’h