Dentist Alpharetta: Denied Dental Procedures Alert

Insurance-Page-ImageA 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

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.

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Dentist Alpharetta: Dental Insurance Code Bundling Alert

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.

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Sandy Springs Dentist: How often should I get my teeth cleaned?

Oral ExamGood question because there is no simple answer.  That’s not what you thought the answer would be. However, I read a recent article suggesting that one cleaning per year may be enough for a certain portion of our population.  And yet the article suggested that for those with one or more of the three risk factors – smoking, diabetes and genetics- 2 dental cleanings would be necessary.  And for the segment of our population with 2 or more of the 3 risk factors, more than two times a year may be needed.  So where do you fit in, are you zero or three for risk factors?[1]

What the study failed to address is a genetic factor that would necessitate 3 or more visits per year?  We know there are those who are at greater risk, but we don’t have a scalable method to determine those with increased risk and those who are not at risk.  And to compound the issue, the insurance companies won’t allow dentist to diagnose for the difference.  Each patient presents a unique set of characteristics, but is treated by insurance companies in a cookie cutter approach.  As a result both patients and doctors are left to navigate what would otherwise be personalized medicine.[2]

As a health care provider I tried to distance myself from what the insurance industry dictates and stay true to my professional teachings.  However, we as a society need to change how we look at our global health care system.  One of the aspects the study failed to address is that Concordia Insurance has found that those patients who seek routine oral care on a regular basis reduce their overall health costs and improve their global health. So by correlative analysis, it would make sense to see your dentist at least twice a year.

If we can help you determine a more personalized treatment please give us a call, because what your insurance will pay is at the bottom of consideration in our practice.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

www.rightsmilecenter.com

info@rightsmilecenter.com

FAQ of the Right Smile Center

FREQUENTLY ASKED QUESTIONS

Drs. Zoey, Novy and HannaWhat type of insurance does the practice take?
We will be happy to work with most dental insurance programs and process your forms at no charge. We will accept assignment of benefits for the portion covered by insurance and will help you make financial arrangements for your personal balance.

We are an out of network provider. Our business office staff will assist you in determining what portion of your treatment is covered by insurance. We will strive to help you obtain your maximum benefits by prompt and efficient processing of your claims. When questions arise regarding your insurance, please feel free to ask. Please bring your insurance card or papers on the first visit. We will help you in every way possible. Please understand that you are ultimately responsible for payment of all services. Should your insurance not cover what is predicted, you will be responsible to pay any uncovered portion.

Does the practice offer financing? 
We are sensitive to the financial concerns of our patients. Most dental insurance programs simply don’t cover some or all of the treatments you and your family may require. Drs. Scheinfelds, Orland & Tourial have developed financing services that help meet these expenses. Speak to our patient services coordinator to find out how we can help develop solutions to your financial concerns so that you may receive the treatment that you need.

What are my payment options?
We accept most major credit cards (MasterCard, Visa, American Express & Discover). For your convenience, we will also assist you with billing your insurance for your treatment plan at no additional cost to you.

If you have more financial questions
Our Patient and Insurance Coordinator will be happy to answer any of your financial questions. She can be reached by calling our Sandy Springs, GA dentist’s office at 404-256-3620 . If you would like to contact her by email at info@rightsmilecenter.com.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

http://www.rightsmilecenter.com

info@rightsmilecenter.com

Connecting Obamacare dots.

Connecting Obamacare dots.

Health InsuranceClick on the title (link) above to read this insightful article by Dr. Hal Scherz, who is a pediatric urologist at Children’s Healthcare of Atlanta. Putting the dots together can be a very scary premise, but a realistic one.  Insurance companies are already raising premiums with increasing benefits and hospitals are acquiring medical practices.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

info@rightsmilecenter.com

http://www.rightsmilecenter.com

Dentist Sandy Springs: Alert – Denied Dental Procedures

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, 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.

 

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Dentist Woodstock: The Difference between Dental and Physician Health Care Costs

Why the cost of your dental care really hasn’t increased that much?  In fact it has either tracked or lagged behind the consumer price index and this is despite all the advances in dental technology.  Compare that observation to your medical care costs.  If you go in to see your dentist and ask for an estimated cost of treatment, 9 times out of 10 you will get a quote.  Try doing that in your physician’s office.   Why?  Because your dental care has been a product of the free market system.  The insurance companies have never yet to invade the purview of your oral health the way they have dominated, if not destroyed your overall health care.

You get your teeth examined, cancer screening, teeth cleaning and x-rays twice a year for less than $300.00.  And that’s about two hours of actual treatment from your dentist and his/her team.  At the physician’s office you go in once a year, see your physician or his PA for about 10 to 16[i] minutes on average and it costs $300 to $900.00, depending on possible immunizations and your blood work (which costs more than twice what an independent lab charges if you have it done outside of your physician’s office).   Physicians are paid by insurance and Medicare submittals based on the procedures they perform and not by the amount of time they spend with you.  So the quicker the visit the more procedures they can bill your insurance.  If they take too long it cost them money, not you.  And all their revenues are based on negotiated fees with your insurance company, not the free market system.  Ah, the key phrase – free market system.  Dentistry never bought into insurance coverage for your treatment and care, and as a result of the free market system there has been a reasonable or to put it better, a withstandable increase to the cost of your oral health care based on the supply and demand curves.

So how much does insurance influence the cost of your health care?  Anecdotally, let me tell you about my daughter’s, but really my experience with health care and why we are the losers in this battle to secure adequate health care treatment at an affordable price.  My daughter had a cyst under her eyelid.  It was not visible to you or me, but it irritated the dickens to her cornea.   I found a specialist and accompanied my daughter to the physician.  It was determined that the treatment required general anesthesia to safely perform the surgery.  When I asked ‘how much’, I received no answer.  I was passed on to the patient coordinator for that physician.  So I asked ‘how much’, and again I received no answer.   They didn’t have a clue what this was going to cost me.  So I immediately said ‘sign me up, I’ll take two’.   Seriously though, they needed my insurance carrier and they would let me know, great.

I get a call from the physician’s office.  It’s going to cost you $800 and change.  Ok, great, and is that my drive out price?  ‘Oh no, that’s just the doctor’s fee.’  Ok, so what else?  I have to call the surgical center.  Ok, how much does that cost?  We [the doctor] don’t know, you just have to call and find out.  So I called.  The gentleman quoted me $1540.00 including 2 hours of facility and the anesthesiologist.  ‘Oh, and you won’t be needing a biopsy, since this is cosmetic.’  No wait, this is not cosmetic, it’s required surgery.  So the gentleman backs up and re-quotes the price.  It will be $4 to 7 thousand for the surgical suite, $1800 & change for the anesthesiologist and X amount of dollars for the biopsy.

Wait, hold on, back up a minute, you just quoted me a price that is almost 7 times what the same procedure would cost if it was elective surgery.  Ah, that key phrase creeps back in to the conversation.  Under a free market system, elective surgery only garners what the market will bear.  But under an insurance based system, physicians don’t know what it costs, so they inflate the costs and hope for some remuneration equal to or in excess of what it really costs under a free market system to treat you.  In other words, it’s a crap-shoot your physician is playing with your health insurance company.   And the loser is you.  So the next time you go to the physician or the dentist, remember why you’re paying what to whom, the physician or your insurance company.  And the next time you discuss health care reform; you’re probably talking about insurance reform.  If we can answer your questions or concerns, please do not hesitate to contact us.

Novy Scheinfeld, DDS, PC

5471 Bells Ferry Road,

Suite 200

Acworth, GA 30102

770-928-7281

info@rightsmilecenter.com

www.rightsmilewoodstock.com

 

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[i] About.com, Trisha Torrey, November 14, 2008.