Dental Sleep Medicine Insider February 2016 | Page 11

LESIA CRAWFORD been approved providers into a medical plan. Usually a fee schedule is approved and there is an agreement to lower fees and overall costs to the insurance company and the patients for treatment or services. A contract is signed between the insurance plan and provider and there are rules and regulations that must be met to comply with the plan. OUT OF NET PROVIDER “Out of network provider” The doctor, office, or facility does not have a contract with an insurance plan. This would pertain to most dental offices operating in the medical arena. Therefore, they do not have to lower fees or follow any specific guidelines outlined for an in-network provider. They can also balance bill the patient for any services and costs over the plans allowed amount. If you can stay out-of-network, I suggest you do. 11 GAP This signifies a “gap in the network” This is the only one that is not an acronym but if I were to make one up it would be “Good As Paid.” This one also has many different names depending on the insurance company and their own lingo. Network deficiency, in for out, network exception, and GAP all mean the same thing. In English, this means that the insurance plan offers an exception to the “in” versus “out” of network benefits. If there is no “in network” provider who can perform the services, then, if approved, they will process and pay the claim using the patients in-network benefits. This means the patient has less out of pocket, the provider gets paid more, and everyone wins. This is always our goal BTW. Stay tuned for the March issue of the DSM Insider for volume 2 of the Medical Billing for Dentists Glossary. To be continued….. Lesia Crawford, CEO of GoGo Billing GoGo Billing offers help with Tricare registration for no charge and Medicare credentialing services for DME, Part B and Ordering and Referring. Enter code DS3100 for $100.00 off DME and Part B credentialing. Contact me at [email protected] or call [phone] ext. 1.