![]() If enough people let them know their discouragement with their benefits, they might improve the plan. I would certainly encourage you to comment on this to your dental benefits coordinator. I asked my bookkeeper about your insurance coverage and she informed me that the plan you have is one of the lowest-coverage dental plans of the hundreds she works with. Although I can find no problem with what was billed, I have instructed my bookkeeper to credit your account for one of the fillings as a gesture of goodwill. The only thing I can think of is that we said that three of them were cavities (the fourth was a broken filling but not decayed), or that three of them were in the same lower right area (a fourth was on the upper area). I’m still not sure where the confusion came from, as four teeth were marked as needing restorations at the check-up appointment, and four were done at the filling appointment. My bookkeeper gave me the letter you sent with your concerns, and I have looked into the billing. John, feel free to call me if you have any other questions. In recent years, though, they are opting for the less costly packages, which means less inclusive dental coverage for the employees. For the most part, employers can get any kind of coverage they want for their employees. The employers need to know because they are the ones purchasing the dental insurance package for their employees. I am constantly expressing my concerns to the insurance companies. The more people complaining of problems with coverage, the more likely it is to be improved. I would strongly encourage you to bring up your concerns with both the insurance company and your employer. Often the patients are better at keeping us up-to-date than the insurance companies are. Patients need to familiarize themselves with the details of their particular plans, closely monitor their benefits, and keep us informed of their current status and any changes. Individual insurance plans often change details every single year. There are literally hundreds of dental insurance plans, each with different maximums, percentages, covered procedures, and so on. WDS has been a leader in electronic insurance processing and information transmittal, but it is still far from perfect. We have no way to monitor what other offices have billed, and what the insurance company has paid other providers. We can usually estimate with pretty good accuracy, but it still leaves one factor out of our hands-the annual maximum. When a patient is referred to a specialist for part of their dental treatment, we try to estimate what our portion of the charges will be, and find out what percentage of that procedure is a covered benefit by your plan. When I started worked in my father’s dental office in 1976 most plans had a yearly maximum of $1,200 to 1,500 this could pay for extensive dental work, and was rarely used up. One of the secrets that insurance companies have kept very quiet is the fact that they have not raised the annual maximum benefit in many years. Dental insurance coverage is simply not going as far for patients as it has in years past. Managed care is finding its way into dental insurance just as it has on the medical side. ![]() I see this frustrating situation occurring more and more. Thank you for sending me your letter with your insurance payment concerns. Please provide a full health history plus a current medication list.ĭo you feel that the patient can tolerate the following procedures without serious or undue complications? This patient was unable to provide an accurate and thorough medical history. Thank you so much for your time and attention.ĭoes this patient require subacute bacterial endocarditis prophylaxis? Please review the checked areas below, write your recommendations, and return to our office as soon as possible to prevent delays in treatment. We need to consult with you regarding the following matter(s). ![]() The above named person is a patient at our dental office.
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