Cross Over Dental Enterprises- Medical Billing for Dentists
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Bone Graft

Bone Grafting, Socket Preservations, and Sinus Lifts

Bone grafts and sinus lifts are routinely denied as not a covered benefit by most dental insurance companies.  As a result of the lack of coverage from dental insurance companies many dental offices are doing the following:

A.    Doing it for free- In this scenario the provider feels so strongly about the necessity that in some cases they give the treatment away in order to be able to place the implant properly in the near future

B.   Not charging enough- Many dentists we speak to before working with us charge $400 to $600 for socket preservation grafts.  When you look at most charges in dental the fees tend to be 6 to 9 times the actual expense.  For example, when doing a crown if there is a laboratory expense of $200 the office may charge $1200 which is 6 times more than the cost.  Many dentists report purchasing bone grafting materials at approximately $150 but then only charge $400 to $600 which is far below the usual formula used by many dental office for calculating fees.

C.   Not doing bone grafts – For some case acceptance is very difficult or incorporating the procedure is difficult.

Many medical insurance carriers, however, consider bone grafting for socket preservation a medical necessity in preventing future disuse atrophy and for restoring the bone levels that may have been lost due to an abscess, fracture, etc.  In the case of sinus lifts we may be correcting severe maxillary atrophy and again many insurance carriers may find this medically necessary.


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