Читать книгу Dental Letters: Write, Blog and Email Your Way to Success with CD-ROM - American Dental Association - Страница 17

Date

Employer Street Address City, State Zip

Dear Employer:

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].”

I suspect that you and your employees may 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 plan fees are determined, the reader of an explanation of benefits (EOB) statement may conclude that my fees are excessive. Consequently, this message may cast doubt as to the appropriateness of my fee for that procedure, and in doing so, could interfere with the dentist-patient relationship.

As the provider of this dental benefit plan for your employees, I believe that you and your employees deserve a benefit plan that adequately communicates the provisions of your benefit plan in language that is easily understood by your employees.

The American Dental Association recommends that insurance carriers 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 with [insurance carrier] as it adversely affects not only my practice and patient, but also may also affect your other employees covered by the plan. Thank you for your attention to resolving this concern.

Sincerely,

Dentist

Enclosure