牙医报销猫腻

半年前人生第一次做深度洗牙,很多单词和流程没太懂。分了两次洗,每次在诊所洗完牙,前台现场扣款188刀,前两天又去诊所做普通洗牙,现场让约4个月一次,我牙齿没啥毛病,记得保险是6个月保险一下普通洗牙,所以现场我改成了6个月后,前台这次也让我直接走了,感觉有猫腻,翻保险EOB,发现之前深度洗牙your share一次108刀,一次88刀。这次普通洗牙也扣成了D4910, 而不是D1110。这次普通洗牙是个年轻男牙医,经验不太足吧,洗牙水滋得我像流口水,上次是个中年牙医,也是诊所主要医生。感觉这次普通洗牙比上次深度洗牙还干净。请问,问了chatgp,说是overpayment了,请问大家,可以联系牙医诊所把钱要回来吗?需要把D4910改成D1110吗?牙医这么扣费是常规操作吗?

表达能力应使用gpt过一下再发出来:

根据这个人的描述,以下是洗牙经历的详细时间线和费用情况:

洗牙经历总结

第一次深度洗牙(半年前)

  • 类型:深度洗牙(Deep Cleaning)

  • 次数:分两次完成

  • 现场支付:每次 $188,总计 $376

  • 保险EOB显示的实际应付金额

    • 第一次:$108

    • 第二次:$88

    • 总计:$196

  • 多付金额:$376 - $196 = $180

  • 医生:中年牙医(诊所主要医生)

第二次普通洗牙(前两天)

  • 类型:应该是普通洗牙(Regular Cleaning)

  • 现场支付:$188

  • billing编码:D4910(深度洗牙编码)- 错误编码

  • 正确编码应该是:D1110(普通洗牙编码)

  • 医生:年轻男牙医

  • 约诊建议:诊所建议4个月一次,患者改为6个月(符合保险覆盖)

问题汇总

  1. 第一次深度洗牙:现场多付了$180

  2. 第二次普通洗牙:被错误地按深度洗牙收费和编码

  3. 总体:可能存在系统性的overcharging问题

保险政策

  • 普通洗牙:保险每6个月覆盖一次

  • 患者牙齿状况良好,无重大问题

这种情况确实需要联系诊所要求更正billing和退款。

3 个赞

How do you know that they performed 深度洗牙 instead of 普通洗牙(D1110) the first time :sweat_smile: They may overcharge you twice already

普通洗牙直接开洗,深度洗牙会给牙龈麻醉,但这三次洗完后的感觉几乎一样

不太想过度依赖gpt,虽然你这格式写得跟检查书一样规整

最后还是联系诊所把钱要回来,是吧?

WHAT IS CDT CODE D4910?

CDT code D4910 is designated for “Periodontal Maintenance.” This procedure is necessary for patients who have been treated for periodontal disease and require ongoing care to prevent recurrence. D4910 includes:

  • Removal of plaque, tartar, and bacterial deposits above and below the gumline

  • Periodontal evaluation to monitor pocket depths and gum health

  • Potential localized scaling and root planing, if needed

  • Typically performed every three to four months, as determined by the patient’s periodontal condition

D4910 is only applicable after active periodontal therapy, such as scaling and root planing (D4341 or D4342), and is considered a maintenance procedure rather than a preventive service.

KEY DIFFERENCES BETWEEN D1110 AND D4910

Feature D1110 (Prophylaxis - Adult) D4910 (Periodontal Maintenance)
Purpose Preventive cleaning for healthy patients Maintenance for periodontal patients
undefined :— :—
Patient Type No history of periodontal disease History of periodontal disease
undefined :— :—
Procedure Plaque and tartar removal above the gumline Plaque and tartar removal above and below the gumline
undefined :— :—
Frequency Typically every six months Typically every three to four months
undefined :— :—
Insurance Coverage Often covered under preventive benefits Often covered under periodontal benefits
undefined :— :—
1 个赞

是的,医生应该给我用D1110,感觉诊所就是随便乱扣费

我几年前深度洗牙后的第一次routine cleaning也是D4910 (Periodontal Maintenance)。
reddit上网友说是,有牙周病的话只能做D4910而不是D1110 which is for patients with healthy gums and no history of periodontal disease。

1 个赞

首先好奇為甚麼要做保險不包的深度洗牙。

其次普通洗牙如果是為了保險而做的,你下次就開宗明義告訴診所:先查保險,保險不包的不做。

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我们保险是部分cover深度洗牙,而且诊所接待新病人时要求先做完整的深度洗牙,才让做普通洗牙,还是看病时不够硬气吧

牙医诊所差距很大,建议换几家都试试。

终于看懂了