Information For Patients
My Dental Office Offers Medical Billing
You or a family member recently visited your dental care provider and were informed that their office accepts and processes medical insurance!
Once you have provided authorization for your dental provider to submit the claim to your medical insurance carrier, your claim is recoded to adhere to CMS and Medicare coding standards for commercial insurance and Medicare supplement plans.
NOTE: Regardless if you have a commercial insurance plan or a Medicare supplement plan, insurance claims are all priced and coded the same. Medical insurance rates are set by CMS and are higher than standard dental rates. All reimbursement(s) from your medical insurance plan will be applied to your patient account based on the medical allowable rates and the reimbursement received. As medical claims are filed, the rate for services is adjusted within the patient's chart to the standard medical allowed amount governed by CMS for the rendered service. In the rare event that medical denies your claim, your rate will be readjusted to the lower, standard dental rate.
Deductible and Co-Insurance
Your dental provider most often will be credentialed with the medical payer as an Out of Network provider. This means if your policy allows out of network services, your services will be covered at the out of network rate. Some offices are credentialed within the payer network depending on the provider type. Your treatment coordinator will let you know what your deductible and co-pay, if applicable, will be prior to scheduling services.
The Dental Office Asked for My Medical Records from My PCP
Sometimes claims are sent for further medical review at the payer. This is a small percentage, but for the payer to ensure services are truly medically necessary, they may request your medical records. Please have them faxed to claimSTAT directly at 866.578-8191
I received a EOB in the mail. It says my claim was denied.
Insurance companies bank on providers not returning a denied claim for further processing. This is part of their strategy. However, long before your received that notice in the mail, we were notified electronically and corrected / recoded the claim. It is already back in process!