can calculate your share of the dental expense in advance.
You may wish to talk with your employer or benefits administrator about the value of direct reimbursement — they may not realize that 88 to 90 percent of the money spent on employees’ dental coverage under a direct reimbursement plan goes directly to care and not to overhead or administration of a more complicated dental insurance plan.
For more information about direct reimbursement, call our office at [office number]. It is our pleasure to provide you with quality dental care.
Sincerely,
Dentist
BLOG POST
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The Benefits of Direct Reimbursement IN RECENT YEARS, CORPORATE BELT TIGHTENING AND INSURANCE COMPANIES MAY HAVE LIMITED YOUR CHOICES WHEN IT COMES TO DENTAL CARE. When your employer implements direct reimbursement, you visit the dentist of your choice, receive treatment, and arrange for payment. After your appointment, you present a paid receipt or proof of treatment to your employer or plan administrator for reimbursement. In addition, many plans will allow benefits to be assigned directly to the dental office. This plan reimburses you based on total expenses incurred. There are typically no deductibles and few excluded services. It frees us to determine exactly the care you need for a healthy and long-lasting smile. Direct reimbursement also helps you avoid unpleasant financial surprises since you can calculate your share of the dental expense in advance. Talk with your employer or benefits administrator about the value of direct reimbursement. |
Letter to Insurance Carrier Regarding UCR
Date
Insurance Carrier Street Address City, State Zip
Dear Insurance Carrier:
I recently received a copy of the [insurance carrier and type of correspondence, i.e. EOB]. I am concerned with the text referenced by [remark code number] printed on the [type of correspondence].
The text referenced by this remark code reads:
“[remark code text].”
Generally, plan members and patients have little or no access to information about what constitutes the Maximum Allowable Benefit or how it is determined by [insurance carrier]. Without an explanation of how your UCR plan fees are determined, my patient may conclude that my fees are excessive. This message may cast doubt as to the appropriateness of my fee for that procedure, and in doing so, may interfere with my professional relationship with my patient.
The American Dental Association recommends that [insurance carrier] use the following statement in its EOB to the patient in lieu of stating that the covered amount represents the “reasonable and customary” expense:
“Reimbursement for this service is limited to the allowable charges as outlined in the Covered Dental Expense section of your plan. Any difference between the dental plan amount and the doctor’s original fee may be your responsibility.”
I urge you to address this matter as it adversely affects my practice. Thank you for your attention to this concern. Please notify my office when this has been corrected.
Sincerely,
Dentist
Letter to Insurance Carrier — EOB Language for Not Dentally Necessary Services
Date
Insurance Carrier Street Address City, State Zip
Dear Carrier:
I recently received a copy of the [insurance carrier and type of correspondence, i.e. EOB]. I am concerned with the text referenced by [remark code number] printed on the [type of correspondence].
The text referenced by this remark code reads:
“[remark code text].”
This text clearly implies to the patient that the services rendered were unnecessary or unprofessional. No information was provided to the patient or to me as to why or how this determination was made. This message may cause my patient to doubt the appropriateness of this particular procedure. In doing so, it may interfere with the dentist-patient relationship.
The American Dental Association recommends that [insurance carrier] use the following statement in its EOB to the patient in lieu of stating that the services were not necessary:
“This service is not a covered benefit as outlined in the Covered Dental Expense section of your plan. The fee charged by the provider for this service may be your responsibility.”
Additionally, your EOB did not indicate whether or not a licensed dentist reviewed the claim. If a dentist did review the claim, then the name and contact information of the dentist should be provided. This information is necessary so that I may contact the dentist to discuss treatment decisions on a professional level.
I urge you to address this matter as it adversely affects my practice. Thank you for your attention to resolving this concern. Please notify my office when this has been corrected.
Sincerely,
Dentist
Letter to Employer Regarding UCR
Date
Employer Street Address City, State Zip
Dear Employer:
I recently received a copy of the [insurance carrier and type of correspondence, i.e. EOB]. I am concerned with the text referenced by [remark code number] printed on the [type of correspondence].
The text referenced by this remark code reads:
“[remark code text].”
I suspect that you and your employees may have little or no access to information about what constitutes the Maximum Allowable Benefit or how it is determined by [insurance carrier]. Without an explanation of how plan fees are determined, the reader of an explanation of benefits (EOB) statement may conclude that my fees are excessive. Consequently, this message may cast doubt as to the appropriateness of my fee for that procedure, and in doing so, could interfere with the dentist-patient relationship.
As the provider of this dental benefit plan for your employees, I believe that you and your employees deserve a benefit plan that adequately communicates the
