and that was worth fighting for… for my patient.
I got the phone number at the insurance company and spoke to a “claims specialist”. I demanded to speak to the person who had the audacity to deny this claim (yes, I can be a little annoying). His response: “Sorry, Dr. Simmons, you need to write another appeal specifically asking to speak with our dentist. Be sure to include the times you are available to take a call and we will get back to you.”
Having already put in the time—way more than I should have—and wanting to get the insurance benefit for my patient, I wrote a letter. I figured I had nothing to lose. My letter was blunt and basically made the strong claim that as a ‘consulting dentist’, denying evidence that is clearly black and white could, in a sense, be considered malpractice. I didn’t sugar coat it. In the. All. This letter was nicely packed with all supporting documents and removed. We were waiting and, in all honesty, I was So I wanted that phone call…
Well, well, well… wouldn’t you know it… not two weeks later, My office manager came dancing into my office with a check in hand for the full amount of the claim submitted. Happy dancing and scoring for the small business owner and patient! It was indeed a good day.
KA-POW❗️ 💥💥💥💥💥
What are the download points at home? First, I think insurance companies deny submissions because they want to see if you persist in pursuing a denied claim. They know we don’t have much time to dictate a letter or an appeal. More often than not, it gets kicked under the rug and the patient gets the short end of the stick. Second—and I tell my patients this all the time—is that insurance companies do not they have their backs. They could care less about what happens to the patient. And the irony behind this is that when a claim is refused, suddenly, the patient thinks the toothy onet is at fault and the service we provided it wasn’t needed. Our ability as a competent dental provider is under scrutiny. It’s almost as if we have to revalidate our trustworthiness to our patients for someone they’ve never met, aka a ‘consulting dentist’.
Sometimes we need to step outside the clinical environment and flex our muscles in the business arena. The fact is, if we get weak here and don’t stand our ground, clinical treatment is hard to justify, especially when there are bills to pay. Do I like writing letters? No. Do I like dealing with insurance companies and being put on hold? Em no. Do I learn something every time though? Yes. Do I value my front desk and office staff more as a result? Absolutely! The practice of dentistry is a team effort.
The face of dentistry is changing, and it is imperative that we stay on top of things by stepping out of our comfort zone from time to time. Flex those muscles! This is how we become better. Simple. Send me your stories. Let’s talk.
Cheers, everyone!
