the right smile

Educating Patients on their Oral Health Options

Dentist Alpharetta: Dental Insurance Code Bundling Alert

Leave a comment

Health Insurance Insurance-Page-ImageApparently, 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

info@rightsmilecenter.com

www.rightsmilecenter.com

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.

Related articles

Advertisements

Author: Drs. Novy and ZoAnna Scheinfeld and Hanna Orland

Our team provides your family with contemporary, rewarding, and comfortable dental care. In our Sandy Springs office, patients come first. Everything we do, from the office design, to our clinical and management training, to the friendly atmosphere we foster in the practice, is for your pleasure and satisfaction. Dr. Scheinfeld, a graduate of Emory University School of Dentistry and her associates understand the importance of balancing health and beauty for an amazing smile. Our comprehensive studies in cosmetic dentistry, restorative dentistry, and general dentistry, supported with state-of-the-art technology, deliver the strong, healthy, beautiful smile you deserve—the smile you'll feel comfortable sharing with your world.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s