factchecker62
Winston-Salem,#2REBUTTAL Owner of company
Tue, November 04, 2014
Our dental practice works diligently to provide excellent service in all phases of the patient experience. From time to time, there is difficulty in interpreting the sometimes arbitrary rules that insurance companies impose on the dispensation of benefits and rely on fine print in contracts that the doctor never sees. for the most part, the patients understand even less. Some information about coverage isn't learned until the actual claim is filed and it is almost always in the favor of the insurance company. With all of the various companies, policies and groups within a given company, it is virtually impossible to avoid conflicts. In most cases there is not a problem with the treatment itself, but who is responsible for the "bill". The other complicating factor is that this patient waited until their dental problem was urgent and wasn't accustomed to the filing of claims for their own insurance company and of course blames the doctor when expectations that "insurance covers it" are not met. When patients delay or defer dental treatment until it hurts or a front tooth needs to be removed, they create this situation and there isn't time to get written authorizations from the insurance company.
We understand the frustration but try to work it out to minimize the out of pocket expense to the patient. When it comes down to brass tacks, the insurance company only cares about "the contract" and minimizing what benefits they pay with your premium dollar, the less they pay out, the more they keep, they are difficult to contact and that is on purpose. The doctor is obligated to recommend and perform treatment that is in the best interest of the patient. We cannot let a large insurance corporation dictate what is the best interest for our patients. Sometimes we make mistakes and sometimes patients need to accept more responsibility for the actions that led them to the health problems that they wish someone else should pay for.