How To File Insurance Claims
1. Call your insurance company to verify your subscriber status, obtain a unique ID subscriber number from them, and verify address to send claim. If you give them the date, procedure code, fee, they can tell you the amount of your reimbursement. Also, request that they do not print your Social Security number on any EOB, (Explanation of Benefits) and inform them that you have a copy of your Dental Service Report and will be mailing it via certified mail.
2. Be sure to sign your Dental Service Report and write your Unique ID number on your Dental Service Report.
3.Make COPIES of DENTAL INSURANCE CARD and DENTAL SERVICE REPORT. If additional copies of your Dental Service Report are requested from this office because insurance company lost the Report, then this office may charge a $50.00 fee for replacement copies.
4.Mail copies of your dental insurance card and Dental Service Report above Certified Mail to show proof that was claim was received by insurance company. Send only one claim per certified envelope. Do not send any other information to insurance company (especially those old had written non HIPAA Compliant ADA forms) because they get confused easily and may not make reimbursement.
Notes and Privacy Statement:
If insurance Company looses a claim with confidential information or has missing information, Report loss to their HIPAA compliance officer employed by them. Please note, insurance company lost missing information puts everyone at risk for identity theft and other crimes. There are stiff fines and prison sentences for violating privacy, including $100,000.00 fines and 10 years in prison for each violation.
Because of the high frequency of deliberate lost claims forms in the custody of insurance companies, any correspondence leaving this office will not contain social security numbers or other high risk information.
To protect privacy, additional (confidential personal) information is NOT released especially to anonymous callers to this office. Social Security numbers and other confidential personal information are not collected, stored, maintained, released, or disclosed from this office under any circumstance.
The dentist does not sign any forms because of the potential for fraud. In the past, this dentistís signature and confidential information has been used maliciously on those old standard non HIPAA compliant hand written ADA dental claim forms without the knowledge of the dentist in some serious cases of fraud. That created a very ugly situation with lingering effects to this day. That will not be permitted to happen again.
This Dentist does not release his social security or TIN number to anyone for any purpose because the insurance companies do not protect confidential information. Since this dentist does not have any direct financial transaction with insurance companies, there is no reason to release it to them. One reason Insurance company employees do not release their true identity is because they have criminal conviction backgrounds and there are various cases where insurance company employees were prosecuted and convicted related to defrauding their own customers.
There are additional layers of liability being added with the new NPI (National Provider Identifier) starting May 23, 2007, and after that date, patients may have to seek treatment from providers who specifically accept their insurance plans. There is a possibility that paper claims without the NPI from non participating dentists may still be accepted for reimbursement purposes. Of course the tele- marketers have accessed this online confidential information and are using it against providers.
One Alternative to insurance is to take cash salary instead of dental insurance. Dental Insurance costs more than dental treatment typically. Insurance companies have not increased annual Dental benefits in more than 30 years. Insurance is a ponzi scheme where they make promises that they have no intention of keeping.
Patientís whose Insurance Companies who fail to pay the claims based on false excuses may not be accepted for further treatment. Do not call and reprimand the dentist if Insurance Company does not pay. The insurance companies frequently blame the dentist typically for any missing information. The dentist does not accept liability for lost, missing or unpaid claims.
If you feel that the Insurance Companies are unfairly denying your benefits, Call the insurance fraud hotline, your insurance company can supply the number for you, and report your insurance company to the fraud hotline. Also report the failure to reimburse to your employee benefits coordinator.
The intent of the office of Robert Hench DMD is to provide dental care to patients who donot have insurance. When the insurance liabilities out weight the benefits, then changes are necessary to improve quality of life.