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.