Custom Abutments and Insurance

[DentalLabHombre]

Does anyone know roundabout, what Dentists are allowed by insurances to charge on custom abutments??

 

[JohnWilson]

You realize every plan is different, there is no cap or bottom to definitively state a number and be correct.

There are a ton of ways to get more from INSCO but its all grey areas.

Like a prefabricated abutment and a cemented crown may give more to a practitioner than a SCREW retained crown. Even though we are doing a zirc crown and cad base and cemented in the lab it is essentially a stock abutment and a cemented crown.

Compensation on most plans is bad, and while it is now the "standard of care" still many plans show it as an elective procedure.

 

[lcmlabforum]

If a prefab abutment is used, and I think a CAD/Ti-Base would fall into that category, I would be very surprised
if the clinic do not bill the patient for it.
The question would be is the type and material in the Ti-Base accurately reflected in the patient clinical record,
which it should be, because that is the actual part in contact with the implant and I feel important for the record,
esp. if there are any recalls (which have not happened in a while).
Just my 2 cents.
LCM

 

[DentalLabHombre]

You realize every plan is different, there is no cap or bottom to definitively state a number and be correct.

There are a ton of ways to get more from INSCO but its all grey areas.

Like a prefabricated abutment and a cemented crown may give more to a practitioner than a SCREW retained crown. Even though we are doing a zirc crown and cad base and cemented in the lab it is essentially a stock abutment and a cemented crown.

Compensation on most plans is bad, and while it is now the "standard of care" still many plans show it as an elective procedure.

Totally understand that all insurances are different, but i have some doc's telling me that they are only allowed to bill out "x" amount of dollars for a custom abutment and the Straumann stock and custom abutments cost more than they are allowed to bill, i advise that they should expect to seat third party abutments if cost is a concern. Thanks for your feedback.

 

[CatamountRob]

Totally understand that all insurances are different, but i have some doc's telling me that they are only allowed to bill out "x" amount of dollars for a custom abutment and the Straumann stock and custom abutments cost more than they are allowed to bill, i advise that they should expect to seat third party abutments if cost is a concern. Thanks for your feedback.

I couldn't agree more. Give them their options, them choose and then bill them for it. Their reimbursement rate isn't your problem.

 

[lcmlabforum]

If the DDS is in an insurance that limits how much they can charge a patient for that specific procedure
code, then the treatment is insurance and cost driven. Not the best but that's life.
If the DDS is just billing what the patients's insurance will pay for U & C and unwilling to have
the patient pay more for a better outcome, that is a different thing you might want to explain
the benefits of the higher fees service you provide.
Just my 2 cents so it is not a race to the bottom.
LCM