Confusion from Dental Coding?

Speaking of confusion and inequity, one cannot forget about downcoding, bundling, and disallowed services. Downcoding and bundling create tremendous confusion for patients and may create lack of trust in their dentist. When a carrier downcodes (substitutes a fee for a lower cost service) or bundles (combines services with separate fees into one fee), patients perceive that the dentist or office staff did something wrong.

“Disallowing” dental treatments is questionable because the plans do not use diagnostic and patient preference information the doctor used to make the treatment recommendation to conclude their disallowance/denial. These are unfair business practices by the dental payer industry whose goal appears to be reduced claims cost rather than optimal patient outcome. The business financial goals set forth by the insurance carriers interfere with the patient’s access to appropriate and necessary care, and it’s unfair to the beneficiary and the benefit purchaser. We could argue that it borders on unethical business practice.

One way to minimize confusion and inequity in a dental practice is to implement an in-office membership and loyalty plan for patients. This has been especially appreciated by those patients who assumed they need insurance to visit the dentist. These plans also offer an effective way to assist patients who want to stay with a practice despite financial hardships.

The dental insurance maze can be daunting for patients, dentists, and dental team members. The best way to minimize confusion and inequity is for dentists to educate themselves so they can educate team members and patients. Dentists taking an active role in organized dentistry and advocating for insurance reform is key to reducing confusion and inequity.

All About Teeth LLC can help with billing and other services to maximize your benefits while collecting maximum reimbursement for your practice.




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