The ability to differentiate products and procedures has not always existed though. The explosion in dental technology has allowed this to evolve. The question is often asked, “But will insurance companies allow you to do this?” For Heavens sake people, why do we as health care providers continually ask this question? Remember these words, VALUE ADDED SERVICE. When you differentiate a product or service, it is either a cosmetic or a value added service. These costs are between you and your patient; they are not covered by insurance because they are “created” codes, not covered codes.
I am not an insurance advocate from a provider standpoint, but do understand this: insurance companies provide insurance products to customers. These customers, your patients, are led to believe that their dental insurance is the best thing that ever happened to them. If you slam their purchased product, you’re slamming their intellect, and you will loose patients for doing so.
Most insurance contracts, whether clearly or hidden, allow for value added services and cosmetic upgrades. These services are billed directly to the patient, not to the third party insurer. Billing such services only delays insurance claims because they are usually confused as to the 9900 type CDT codes that you may use to track such procedures.
Insurance provides the basics to their customers (our patients) and certainly does not prohibit their clients from technologically improved prosthetics, restoratives, or services. Most insurance companies just require the patient to be informed for increased value added service costs. However, most want you to have something in writing for the patient to sign. But it would be insurance suicide for their customer not to let the CEO’s daughter, Suzy, have those Da Vinci Crowns on her newly fractured front teeth if their client is willing to pay more out of pocket for better technology. You would bill the insurance the regular D2940 code for an all porcelain crown, and bill the patient a created code, description, and fee for the upgrade. Such a code might read like this: D2995, Lava, $150.
Codes, descriptions, and fees can be created in most practice management software. Just look under the “office manager” icon, go to practice set-up, and then codes and fees. Remember to check the box that says, “Do not bill to insurance”. When insurance companies see an unidentifiable code, they reject the whole claim and require an explanation. Use the phrase, “cosmetic upgrade” to them for everything. Do not attempt to explain the difference between zirconium and pressed ceramics. They are completely clueless and the claim will be delayed further.
Most of the time our worst enemy is ourselves, only because we don’t communicate with our patients about newer and better technologies. Often we don’t know for ourselves what’s out there for lack of continuing education, and we certainly don’t read those insurance contracts from front to back. Allow common sense to prevail.
Dr. Rob…
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