Your dental insurance company has never
met you. So why do you value their opinion?
As the provider on the other side of the triangle, we
understand how “dental insurance” companies really behave. As a caring and compassionate health care
professional, I want to use my education and experience to help you achieve the
best level of oral and systemic health. Unfortunately, dental insurance
companies are not set up to accomplish the same goal.
More often than we would like, after my front office
compiles all of the supporting data and submits the claim to your insurance
company, we receive back correspondence stating that they are denying the
claim.
First, they stated that they did not receive enough
supporting information, which is delay of payment #1.
So you know, we sent:
- X-rays
- Photographs
- Periodontal charting
- And, treatment notes
They respond, “No, we didn’t receive those. Please
resend again.”
So we do. All the while we are designating one of
our employees who now has to be paid to manage all of these communications and
the shuffling of information. After more waiting, we get another rejection,
which is delay of payment #2.
Then the insurance company states, “Our claims
advisor does not feel that there is enough supporting information to support
your claim. Therefore, we are denying the claim”.
My front office team shares with you that your
insurance company, despite all of our supportive documentation, is denying your
claim. We recommend that you call your insurance company for further
clarification as we are getting nowhere. At this point, more than 3 to 4 months
have passed since the treatment and the patient is feeling well and her
symptoms have resolved.
Over the next couple of months, the patient made
calls, we made calls and we both get the runaround about why the insurance
company is not paying.
The strategy is if they can’t outright deny the
claim, then at least delay the inevitable-payment.
After 5 or so months of the insurance company
holding up the claim, we ask the insurance claims supervisor to put us in
direct contact with the lead supervisor who is in charge of your claim. We set
up an appointment for a conversation.
And then “miraculously” on the morning of the day
where I was to talk with this “dental claims expert”, our Patient Advocate and
Insurance Coordinator receives a call from the insurance company.
“It appears that the claim that you submitted has
been “re-reviewed” and is now in process for payment. Would Dr. Scheinfeld or
Orland still like to speak to our dental claims supervisor?”
So a company who has never met you is allowed to be
in a position where they can determine whether payment is rendered for
services. Yet they have never performed an exam on the patient.
They were able to hold up the claim for almost 5 or
6 months. This means greater profitability for the insurance company. Despite
how ridiculous this scenario sounds, we constantly hear from patients who ask
“Will my insurance cover this?”
What does your dental insurance know or care about your health? We will tell you what they know – how to increase their profits by not paying on your just claims in a timely manner. How does this make sense and do you realize how much money in staff time is devoted to your health care delivery? And none of these costs benefit you in any way.
Novy Scheinfeld, DDS, PC
ZoAnna Scheinfeld, MS, DMD
Hanna Orland, DMD
290 Carpenter Drive, 200A
Sandy Springs, GA 30328
404-256-3620
And
3781 Chamblee Dunwoody Road
Chamblee, GA 30341
770-455-6076
info@rightsmilecenter.com
www.rightsmilecenter.com
The Dental Care System is MORE Broken since COVID. The insurer-controlled dental care system has been broken for years! And now, a model that did not work prior to COVID-19 is only getting worse. Patient distancing has forced lower patient volumes and decreased production, while the cost of PPE and infection control further misaligns practice costs and PPO reimbursement. Can your dentist be profitable on our existing PPO fee schedules and terms with a 25-35% decline in production and a 5-10% increase in costs? What happens when PPOs lower your dentist’s fees next year and subsequent years? 
the right smile 