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Can an Oral Surgeon bill patient for material separate from the procedure if PPO insurance allowable doesn't cover his costs?

Las Vegas, NV |

For example Aetna allows about 300.00 for extraction, graft, & general anesthesia but the meds for anesthesia cost 100.00+ and graft material is 2-300.00 depending on size. We would like to bill 300.00 in materials so as not to lose$

Attorney Answers 1


The surgeon must use the appropriate CPT codes to bill his procedures and materials. The insurance industry has a set of codes, and will only pay based on the proper use of those codes. As such, your surgeon must follow industry and insurance requirements in his billing practices. He/she cannot simply "shift" costs to obtain better coverage for the patient.

Responses are for general information purposes only, and are based on the extremely limited facts given. A consultation with an attorney experienced in the area of law(s) indicated in the question is highly recommended. Information and advice given here should not be relied upon for any final action or decision, as the information is limited by its nature to the question asked and the fact(s) presented in that question. THIS RESPONSE DOES NOT CREATE AN ATTORNEY/CLIENT RELATIONSHIP, particularly considering that the names of the parties are unknown.

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