Filing, Tracking and Disposition of Insurance Claims
We have the latest software and hardware for filing and tracking insurance claims. All of our claims are filed electronically and pass through two filters before they are released to the insurance companies. If there is something wrong a claim from our end (wrong code, missing date, etc) we know it the next day and can correct it. We also receive a transmittal when an insurance company receives a claim.
We know the procedures for which insurance companies typically request additional information so we provide it with the claim. We maintain a huge database of the actual dollars paid by thousands of different plans for each dental procedure so we can give you an accurate estimate of what you can expect from your insurance for proposed treatment before you start.
We discourage our patients submitting predeterminations because 1. a predetermination is no guarantee of the actual benefit paid and 2. predetermined cases are assigned to special adjusters who are extremely aggressive in denying or downscale the services claimed.
If a claim is not paid within 31 days, we supply the paperwork needed for you to send a sharply worded letters to your insurance company and make a formal complaint to the Commissioner of Insurance and the Attorney General by simply signing your name and mailing. Because we are so quick to respond to late payments or requests for irrelevant information, insurance companies rarely use these tactics with our patients.
We will advise and supply letters and information for appeals or disputes with insurance companies if we feel our patient is being treated unfairly. Our role however is only advisory; we have no power over your insurance company. We can provide much of the paperwork that simply has to be signed and mailed. The contract is between the subscriber, the employer and the insurance company so the subscriber must become actively involved if an insurance company has not fulfilled its contract
For these reasons, any expected insurance payment not received within 31 days of receipt of a claim will become due immediately from the guarantor of the account.
For our patients who receive their payments directly from their insurance company, it is important that you send us your EOB’s, the paper explaining how your benefit was computed that accompanies your benefit check. Insurance companies notoriously underpay benefits when paying patients directly.