Apparently,
insurance companies are violating their third party payer agreements to reduce
benefits to patients. In order to use
the ADA’s intellectual property, i.e. dental procedure codes, the insurance
companies have to agree not to change the code’s nomenclature and
description. However, what is happening
is your insurance companies are redefining submitted procedural codes with
combined codes that pay you less benefit than you are entitled to. This is called code bundling, which is
designed by your insurance provider to reduce your benefits.
HIPAA
requires that the procedure code reported on a claim be for effective service
rendered on the date of submission.
Unfortunately, there is no effective way for dentists and their patients
to enforce this requirement and the result is a misunderstanding created by
insurance companies that suggests ‘it’s your dentist’s fault’.
The
solution is patient push back for the coverage you’re entitled to. Patients need to question, if not challenge
the benefits they have paid for but have been denied. And patients need to recognize that the
contractual relationship is between you
and your insurance provider, not your dentist and your insurance
provider.
Hopefully,
this is a little helpful in understanding the difficulties of receiving your
full insurance benefits. If we can
answer any of your concerns, please feel free to contact us.
Novy Scheinfeld, DDS, PC
290 Carpenter Drive, 200B
Atlanta (Sandy Springs), GA 30328
404-256-3620
Thank you for all your referrals. We truly appreciate them.
Information included is not dental or medical
advice. For your specific information
be sure to
consult your dentist.
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