full image - Repost: What is dental code D4267 TISSUE REGENER? The more I follow up with complaint, the more codes added to procedure from six months ago. (from Reddit.com, What is dental code D4267 TISSUE REGENER? The more I follow up with complaint, the more codes added to procedure from six months ago.)
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Hi, this has really been an ongoing thing that seemingly keeps developing, so feel free to skip to the fifth paragraph or so.After a decade away (17 during my last dental visit), I went in for some work. I have Amertias/Spirit Dental insurance and my annual benefit amount is $5000.On April 7th, I went in for two extractions and two bone grafts. EXT ERUPT TH D7210 x2 and my responsibility was $158, but I paid $1131.80 for the work. I was told by the office manager that Ameritas does not cover bone grafts, so I had to pay roughly $500 per bone graft. The claim said nothing about bone grafts, so I assumed that meant she was correct - that Ameritas doesn't cover bone grafts and that's why there was no mention of them on the claim.April 27th I go in for a consultation with the oral surgeon. He is only there once a month, so my appointment was scheduled for the following month. I am told I need 7 more extractions (1 wisdom tooth) and 1 bone graft. The office manager tells me the oral surgeon technically does not belong to the office, so he doesn't take Medi-Cal/Denti-Cal. She said the out-of-pocket cost for this work is $2500 (which I found a little odd considering it was like triple the extractions compared to my previous procedure), but she says since I have no insurance/am on Medi-Cal, she can offer a $1000 discount and I just need to pay $1500.May 25th I go in for the work. I had hoped the office manager would realize I had dental insurance, but the price remained the same. I paid $1500 and she tells me it's not that I was on Medi-Cal. It was that I had exhausted my annual benefit amount. They had only charged my insurance $150 from the two extractions in April, so I had ~$4800 remaining. She tells me to bring $2250 for 3 root canals and schedules me for an appointment in 2 weeks. As a grad student who works part-time doing home health care, there was no way I'd have that kind of money so fast. So I just wait.Toward the end of June, I see a claim for the May procedures. D7210 EXT ERUPT TH, D7140 EXTRACTION, D7210 EXT ERUPT TH, D7140 EXTRACTION, D7140 EXTRACTION, D7230 PBI EXTRACT, and D7230 PBI EXTRACT. My responsibility was $623.50 after the charged fee of $3240 was reduced by $1247 for using an in-network provider. A bit concerned, I emailed the office and receive no response. I then call and the billing worker I spoke with said I paid $2500 (no record of the supposed discount) and that they wanted substantially more than what they got from Ameritas, so that I should be happy I paid as little as I did. This is what prompted me to call Ameritas to file a complaint and the worker I spoke with was quite aggressive after I mentioned the dental office had called them cheap. She put me on hold while she called the office herself. She assured me that I was due a credit toward future work, but that the billing supervisor needed to approve it. That credit never happens, so I file a formal complaint.Weeks later, I receive a new claim for the April 7th work. I see D7953 BONE GRAFT x2 and that my responsibility should have been $337. I would have much rather paid that than the ~$1000 I paid for the bone grafts back in April. The office manager assured me though that Ameritas does not cover bone grafts at all. I also see a new claim for the May procedures with D7953 BONE GRAFT x3 and that my half should be $786. I was rather puzzled by this as they told me I was only getting one bone graft that day, not three. At this point, I call Ameritas and they are still investigating. I say I no longer want a credit toward future work and instead want a refund as I believe the office manager was dishonest with me from the start and I'd like to find a new dentist. I additionally leave a bad review on Yelp saying that while I loved the dentists I interacted with, the billing staff and office manager had some questionable billing practices and never seemed to remember who I was/what my insurance details were.Less than two weeks after I leave my bad review, I see a third claim for the May 25th work. It says D4267 TISSUE REGENER x2 and that my responsibility is $2,400. That was my first time hearing of such a thing and I really felt like the billing workers are trying to drain my annual benefit amount, for whatever reason. I just don't understand how they keep finding new dental code/work to add to a benefit claim the more I tried to get a credit/refund. Amertias left this note on this third claim for the same work "INFORMATION WAS EITHER NOT SUBMITTED OR DOES NOT PERTAIN TO THE AREA OF THE SUBMITTED SERVICE".Lastly, this past Friday, I got an email from Ameritas saying the investigation is ongoing as that most recent claim was pending and they also mention something about the California dental board and include a number/some additional information. I reply to the email and CC the dental office for the heck of it. I get a call on Monday, but don't answer. Before I filed the complaint, I would get a lot of texts saying that I was due for my next visit, but those all stopped after I asked for a credit. I didn't like how they chose until now to finally call me. After ignoring the call, I get an email from the owner of the practice himself the very next day. I felt a little intimidated as they completely ignored my email from 5 months ago and suddenly they reply. But anyway, yeah, I guess my real question is what is D4267 and is it common for it not to be mentioned? I really did not hear anything about it. Not even the office manager who seems to handle all of the billing ever mentioned that I was having that done.
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