A denied dental procedure does not mean the procedure wasn’t necessary. It just means your insurance carrier won’t cover it as a benefit of your plan. Limitations in an employer’s group policy most likely result in these noncovered procedures. This is a huge problem for your healthcare provider, because your care provider is trying to do what you need and not what is paid for by your insurance carrier. To compound these denials, some policies are designed such that they do not allow the dentist charge you for certain procedures. However, that does not mean your dentist can avoid the procedure because it may be absolutely necessary as a part of your treatment. This scenario has left your dentist wondering whether or not you will pay for the services being rendered because your insurance carrier is denying a necessary procedure and lack of patient understanding. And finally, this scenario has left your dentist perplexed as to how to overcome the perception by patients that they are not being honest with them.
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. Your dentist has absolutely not leverage with your insurance carrier.
Hopefully, this is a little helpful in understanding the difficulties in receiving your full insurance benefits. If we can answer any of your concerns or questions, please feel free to contact us.
Novy Scheinfeld, DDS, PC
290 Carpenter Drive, 200A
Atlanta (Sandy Springs), GA 30328
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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