Читать книгу Dental Letters: Write, Blog and Email Your Way to Success with CD-ROM - American Dental Association - Страница 16

Date

Insurance Carrier Street Address City, State Zip

Dear 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].”

This text clearly implies to the patient that the services rendered were unnecessary or unprofessional. No information was provided to the patient or to me as to why or how this determination was made. This message may cause my patient to doubt the appropriateness of this particular procedure. In doing so, it may interfere with the dentist-patient relationship.

The American Dental Association recommends that [insurance carrier] use the following statement in its EOB to the patient in lieu of stating that the services were not necessary:

“This service is not a covered benefit as outlined in the Covered Dental Expense section of your plan. The fee charged by the provider for this service may be your responsibility.”

Additionally, your EOB did not indicate whether or not a licensed dentist reviewed the claim. If a dentist did review the claim, then the name and contact information of the dentist should be provided. This information is necessary so that I may contact the dentist to discuss treatment decisions on a professional level.

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

Sincerely,

Dentist