plan in language that is easily understood by your employees.
The American Dental Association recommends that insurance carriers 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 with [insurance carrier] as it adversely affects not only my practice and patient, but also may also affect your other employees covered by the plan. Thank you for your attention to resolving this concern.
Sincerely,
Dentist
Enclosure
Letter to Employer — EOB Language for Not Dentally Necessary Services
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].”
This text may imply 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. Judgments of this kind constitute a diagnosis of the patient’s condition, which cannot be done without examination of the patient by a licensed dentist. Consequently, 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.
As the provider of this dental benefit plan for your employees, I believe that you and your employees expect a benefit plan that meets the oral health care needs of your employees. Plans that deny benefits for treatment deemed unnecessary solely in the opinion of the insurance carrier may not be providing the type of dental care that your employees need and that you and your employees have paid for in premiums.
The American Dental Association recommends that in situations where coverage is not provided by the benefit plan 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, the 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 with [insurance carrier] as it adversely affects not only my practice and patient, but may also affect your other employees covered by the plan. Thank you for your attention to resolving this concern.
Sincerely,
Dentist
Enclosure
Use Your Dental Benefits Before the End of the Year
FACEBOOK POST
|
|
Number One Dental |
The end of the year is almost here! It’s a good time to think about your unmet dental needs and how to use your dental benefit coverage to help pay for your treatment for the rest of [year]. If you have available benefits with your dental plan, please call us to schedule your treatment before the end of the year to make the most of them.
TWEET
|
|
Number One Dental @NumberOneDental Have any leftover dental benefits? Use them before the year’s end. Call today for an appointment! #NumberOneDental |
TEXT
Use your leftover dental benefits before the end of the year and start the new year with a beautiful smile. Call today for an appointment.
Letter to Insurance Company for Nightguard and Cosmetic Approvals
Date
Insurance Carrier Street Address City, State Zip
Re: Patient Patient Date of Birth Patient Insurance Company ID Number
Dear [Insurance Company]:
I am writing to request authorization for [patient] to receive treatment for the diagnosis of [condition]. This treatment is medically necessary to treat the specific medical condition described below. It is not in any way for general health and is not for cosmetic purposes to improve appearance.
The treatment will, or is reasonably expected to, prevent the onset of an illness, condition, or disability. [Provide diagnosis details below.]
OR
The treatment will, or is reasonably expected to, reduce or ameliorate the physical, mental, or developmental effects of an illness, injury, or disability. [Provide diagnosis details below.]
Should you require further information, please do not hesitate to contact my office at [office number].
Sincerely,
Dentist
Coordination of Benefits (COB)
Date
Patient Street Address City, State Zip
Dear Patient:
I understand that you have some questions regarding the coordination of benefits between two insurance plans. The term coordination of benefits
