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Surgical Extraction VHI Code 250E

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  • 11-02-2015 12:54am
    #1
    NGUYEN01
    Registered Users Posts: 44 ✭


    I have to have a surgical extraction of a molar - the VHI code is 250E. It is fully covered by the VHI as a side room procedure.

    My dentist referred me to Specialist Oral Surgeon - this is due to the nature of the extraction. However, the Oral Surgeon is charging over an above the cost being paid by the VHI - a thing call a facility fee for the surgery of €250.


    The VHI have told me that the procedure is cover in full (under my plan) at the Hospital Facility and that he should not be charging me a extra €250.

    I am now trying to find an alternative Surgeon because I don't want to be ripped off. Any suggestions please send me a PM.

    thanks
    Alto


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    #2
    Oral Surgeon
    Registered Users Posts: 3,240 ✭✭✭Oral Surgeon


    NGUYEN01 wrote: »
    I have to have a surgical extraction of a molar - the VHI code is 250E. It is fully covered by the VHI as a side room procedure.

    My dentist referred me to Specialist Oral Surgeon - this is due to the nature of the extraction. However, the Oral Surgeon is charging over an above the cost being paid by the VHI - a thing call a facility fee for the surgery of €250.


    The VHI have told me that the procedure is cover in full (under my plan) at the Hospital Facility and that he should not be charging me a extra €250.

    I am now trying to find an alternative Surgeon because I don't want to be ripped off. Any suggestions please send me a PM.

    thanks
    Alto

    Hi alto,
    I wouldn't presume that you and the Vhi are correct and that the oral surgeon is being underhanded about this...
    Medical insurance covers very specific procedures. "Surgical extraction" per say is not necessarily covered. However the surgical removal of impacted teeth or buried roots of teeth are covered. The important question here is if the tooth in question is impacted or buried in the gum/bone or broken down to bone/gum level so that only the root is present. If the tooth is just a regular tooth, then it's extraction is not covered whether it needs a surgical extraction or not.....
    250E is not a Vhi code, you need to check that one again...
    The Vhi have only told you that you would be covered if you needed procedure x, they have not looked into your mouth and said that it is procedure x that you need!!

    First off, check if the procedure is truly covered. Technical and facility fees are common. The Vhi don't pay handsomely for such procedures these days and provide nothing for consultation, sedation etc.....

    os


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    #3
    NGUYEN01
    Registered Users Posts: 44 ✭NGUYEN01


    Sorry typo on the VHI Code 2930 - yes the extraction is impacted and not a regular extraction. Thanks to my employers I have a very good VHI policy and they are confirmed to me that I am fully covered for the procedure in a side room and that the consulation should not be charge an extra facility fee and the VHI will be paying the full fee directly to the consultant and clinic.


  • Options
    #4
    Oral Surgeon
    Registered Users Posts: 3,240 ✭✭✭Oral Surgeon


    NGUYEN01 wrote: »
    Sorry typo on the VHI Code 2930 - yes the extraction is impacted and not a regular extraction. Thanks to my employers I have a very good VHI policy and they are confirmed to me that I am fully covered for the procedure in a side room and that the consulation should not be charge an extra facility fee and the VHI will be paying the full fee directly to the consultant and clinic.

    2930 is the code for the surgical removal of a root. The code for the removal of an impacted tooth is 2976 if its a lower (impacted) tooth or 2973 if it is an upper (impacted) tooth.

    How good your vhi plan is not important. They all cover the same thing....

    Had the oral surgeon confirmed that this is a root or an impacted tooth or is someone in the VHI call centre blindly listing codes over the phone??


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