Dental Sleep Medicine Insider December 2015 | Page 8

LESIA CRAWFORD e h T s ’Ti on Seas FOR OAT [email protected] | (877)874-GOGO(4646) Ext. 1 for Lesia Crawford | www.gogobilling.com And here it is, the end of the year. At GoGo Billing we have always seen a rush of cases come in at the end of the year asking for quick approvals so services can be rendered before January 1st. Have you sent out your letter urging patients to use up their dental benefits? Use them or lose them, right? With most dental insurance plans patients still have a co-pay to contend with and they may be reluctant to spend their holiday money on dental work. They think, “I still have $1000 left of my insurance money, but I will have to spend $1000 or more to use it.” When medical deductibles and out of pocket (OOP) is met, this equates to services covered at 100% or “free” even when seeing an out of network provider. Yes, you read that right! WHEN MEDICAL DEDUCTIBLES AND OUT OF POCKET (OOP) IS MET, THIS EQUATES TO SERVICES COVERED AT 100% OR “FREE” EVEN WHEN SEEING AN OUT OF NETWORK PROVIDER. Without the OOP issue, patients are more likely to move forward with oral appliance therapy (OAT). OAT doesn’t require recovery time or excessive time away from work so most patients can fit an hour or two into their schedules to take advantage of the only time insurance pays at 100%. I suggest you take inventory of all your potential sleep apnea patients seen throughout the year who did not move forward with treatment because of cost. Your billing company or front office team member can call the payer or get online and review their benefits and run an update on their deducible and out of pocket maximums. If you have already had a preauthorization and network waivers or GAP exceptions completed, remember to check the dates and get an extension prior to treating the patient to cover the procedure date if it has lapsed. MEDICARE EXPLICITLY STATES THAT THE BILLED DATE IS THE DELIVERY DATE. Keep in mind, not all medical plans specify the date of when the E0486 should be billed. With some it’s the impression date and with others, it’s the delivery date. Medicare EXPLICITLY states that the billed date is the delivery date. Be mindful to deliver the appliance before end of year if this is the case. Opening the office for a morning or a full day during your holiday break just to seat appliances will be well worth it. To put it all into perspective, in dentistry there are yearly maximums to contend with. Once dental plan pays out $1000 or $2000 worth of claims the insurance is “maxed” out and there are no further benefits payable until the benefit or calendar year renews. Most medical plans do not have maximum payouts. It is actually the opposite. This is a wonderful thing for you and your patients! A common question our benefits and pre-auth department gets asked is in regards to the OOP maximum, also referred to as the out of pocket limit. Is the OOP the same as a deducible? The simple answer is that once a patient has reached the limit set by the plan of maximum OOP costs, services will be paid at 100%. A deducible is an amount