Just when I thought I had seen it all, we get another amazing statement of denial for needed dental treatment. As most of my patients know, we document, x-ray, photograph, and write-up all the reasons for needed treatment. We literally prove the need for treatment beyond question. Yet apparently the insurance companies are now using tactics to simply deny covered treatment regardless of the obvious.
So, what do we do in our office on behalf of our patients? We go to battle. We are finding ourselves requesting more and more conversations with the dental insurance advising dentist. This is the person who can overturn the denied claim. This peer-to-peer conversation is usually enough to change the denial as you are looking at x-rays and photographs with a colleague. However, they have internal rules and regulations that bind them from doing the right thing. We see that all too often. But most of the time they are reasonable.
So why are dental insurance companies making us do this? It’s common knowledge that a percentage of offices will not go to battle on behalf of their patients and just collect balances from them. And dental offices have the right to do so as it’s not our responsibility to beg for payment from a third party for dental services rendered.
The problem is simply this, dental insurance companies have to be profitable, just like any other business. This is a common stall tactic to leave money in their companies for quarterly earnings reports. They have money coming in from premiums and can’t pay out more money than they take in.
Bottom line, when dental treatment is denied, we request a direct phone call from their advising doctor on our patient’s behalf. Hopefully they still have all the necessary pictures, probing depths, and notes to prove the need for treatment. Sometimes those are “conveniently” lost. We even go to the extent of having our patients on a three-way call with their insurance company so that they, the insurance company, can explain to our patient why they are denying covered treatment, especially when it’s obviously needed. So, don’t be surprised when we ask you to help us help you.
What can the patient do? File a complaint with their Human Resource department. You are the customer of that insurance company and actually hold more authority than we do. Most important, you deserve the coverage you’ve paid for. Don’t let them get away with not covering your oral health care when it’s needed.
Sincerely,
Dr. Rob
www.thorupdental.com