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Insurance issue

I recently saw a pt who needed srp, she had not been to the dentist in over 10 years, had radio graphic calculus on nearly every interproximal, heavy bleeding and multiple 4 and 5mm probings and a couple 6mm as well. Submitted all of this info, X-rays, perio charting, intraoral pictures etc to insurance it was denied. Submitted again with narrative and denied again. What should I do? The pt needed the srp, anything less would have been negligent care.



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2 Answers

I would consider sending a letter from you and have the doctor sign it. I would ask the insurance company exactly what clinical signs need to be present in order to justify SRP for a patient. I might enter any medical conditions that the patient has that could be benefitted by doing SRP. I would talk about standard of care and mention what the dental board in your state and what the ADA says about necessary treatment. Many times, insurance companies are just throwing monkey wrenches into claims in order to either get patients and dental practices to give up or just to delay them having to pay for treatment.
I would be the squeaky wheel and the advocate for the patient. Good luck!!

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I agree with Sue! Also, the patient can be a squeaky wheel as well. Patient needs to call her insurance company and talk to her HR at work (if there is a work and HR). Hair can get things going too.

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