Читать книгу Dental Letters: Write, Blog and Email Your Way to Success with CD-ROM - American Dental Association - Страница 15

Date

Insurance Carrier Street Address City, State Zip

Dear Insurance Carrier:

I recently received a copy of the [insurance carrier and type of correspondence, i.e. EOB]. I am concerned with the text referenced by [remark code number] printed on the [type of correspondence].

The text referenced by this remark code reads:

“[remark code text].”

Generally, plan members and patients have little or no access to information about what constitutes the Maximum Allowable Benefit or how it is determined by [insurance carrier]. Without an explanation of how your UCR plan fees are determined, my patient may conclude that my fees are excessive. This message may cast doubt as to the appropriateness of my fee for that procedure, and in doing so, may interfere with my professional relationship with my patient.

The American Dental Association recommends that [insurance carrier] use the following statement in its EOB to the patient in lieu of stating that the covered amount represents the “reasonable and customary” expense:

“Reimbursement for this service is limited to the allowable charges as outlined in the Covered Dental Expense section of your plan. Any difference between the dental plan amount and the doctor’s original fee may be your responsibility.”

I urge you to address this matter as it adversely affects my practice. Thank you for your attention to this concern. Please notify my office when this has been corrected.

Sincerely,

Dentist