Have you been the target of a dental insurance audit?

This topic contains 1 reply, has 1 voice, and was last updated by  gshankar78 2 years, 4 months ago. This post has been viewed 364 times

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  • #85834
     gshankar78 
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    Have you been the target of a dental insurance audit?

    #85835
     gshankar78 
    Participant

    1. If you can’t read your doctor’s handwriting, you can be sure the insurance company reps won’t be able to either. This is why the doctor should dictate the narrative as you type the information on letterhead. Be sure to explain what was done (although it’s already on the claim form), and most importantly, why it was done. Be sure to emphasize the “need” for treatment.
    2. If the treatment was for cosmetic purposes, you can forget about getting paid. Be sure to focus on explaining why the treatment was necessary from a medical or dental standpoint. Explain the functional reasons using terminology the insurance company reps can understand. Be sure to point out what the desired prognosis is, and any complications the patient may have endured had the person not undergone such treatment.
    3. If the treatment is not 100% visible on x-rays, you need to make sure your periodontal charting explains it. Be sure to indicate if the patient is suffering from recession, loss of attachment, bleeding on probing, pocket depths, bone loss, and other factors that could support the need for the treatment.

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