IN BED WITH THE EDITOR
"DENTISTS CANNOT GET PAID BY MEDICAL
INSURANCE FOR ORAL APPLIANCE THERAPY!"
T
his fallacy has polluted my ears
too many times. It is just that; a
fallacy. Here is how this fallacy
typically plays out in dental practices
across the country every day……
Dr. Dentist is interested in Dental
Sleep Medicine and has probably had
a request from a patient for a device.
He tasks the team member in charge
of billing (we’ll call her “Sarah”) with
submitting the claim to the medical
payer via fax. Sarah calls a couple
weeks later to check the status of the
claim and expected date of payment.
They reply that they haven’t received
anything, oh, and wait, “WHAT! You’re
a dentist???” Sarah faxes the info
again, confirms that it was received
and then calls again two weeks later.
She is on hold for 45 minutes and is
subsequently subjected to a game
of voice prompt ping-pong. She’s on
hold for a total of 2 hours. During this
time, her morale is plummeting and
she isn’t producing in her normal
capacity. Finally, someone comes on
the line and tersely informs Sarah that
“it’s not a covered benefit”, “requires
pre-auth”, “we don’t process dental
claims”, “you’re out of network”, “there
is another in-network provider” or
some other soul-crushing nonsense.
At this juncture, Sarah is plotting a
mutiny after uselessly spending 5
hours in voice prompt purgatory.
She begins to question the meaning
of life and is now a staunch opponent
of dental sleep implementation
in your practice. Also of note, the
insurance company isn’t any closer
to paying you. For services you’ve
already performed. Not. A. Dime.
You walk away from offering this
life-saving,
lucrative
procedure
and become one of the legion of
dentists propagating this fallacy.
What about all of these tales we’ve
heard about dentists receiving $8k
per appliance? It has to be true, right?
Kinda, sorta. Sarah is very capable.
However, she was unable to get you
paid from a medical payer because
she doesn’t know what she’s doing. It’s
not her core competency. I’m unable
to extract #3 or do a chamfer prep.
It can be done. I just can’t do it. Or
maybe I could but I’d do a very poor
job. It needs to be done by a dentist,
someone whose core competency is
tooth extraction or crown prepping.
We’d all laugh (or cry) if someone
went to their chiropractor for this
procedure to save a few bucks.
What are you to do? The answer is
simple. For at least the first 12 months,
outsource medical billing to a 3rd
party biller. There are several. Just do
a simple Google Search (or Bing. I think
some people actually use it). Medical
billing for OAT is a pain. It really is.
fal·la·cy
ˈfaləsē/
noun
noun: fallacy;
plural noun: fallacies
1. a mistaken belief,
especially one based on
unsound argument.
3
Jason Tierney
Editor-in-chief
The Dental Sleep Medicine Insider
[email protected]
314-882-7746
Every payer has different rules and
regulations. Their job is to NOT pay
you. 3rd party billers are skilled in the
area and it is best left to them to do the
job. They also encounter difficulties,
just as you might when dealing with
those aforementioned scenarios.
Fortunately for you, they are adept
at overcoming those obstacles. It’s
still a hurdle but this will ensure your
claims are in good hands, you get
paid as much and as soon as possible,
your team members are productive,
the mutiny is avoided, and your
patients are appropriately treated.