As an oral and maxillofacial surgeon one of the most common issues that our patient’s find frustrating is the paperwork and resulting battles that ensue from insurance companies. In our field we deal with both medical and dental insurances which compounds the problem. There are hundreds of insurance companies out there that provide insurance to our patients and within each of those companies there are several possible “plans” in which our patients may be enrolled. Most people think they have a basic understanding of their coverage or have even called to check on their coverage status prior to the consultation appointment. One of the overriding factors in the frustration that patients have with the insurance situation is a customer service issue. When patients call to check their own coverage the questions that they ask are often too general to be answered specifically. Questions like “Do I have coverage for oral surgery?” will get a general “Yes” response from your insurance representative when in reality your specific plan may exclude impacted teeth, or implants or several of the other aspects of our practice. The insurance company, unless asked specifically, will not be able to tell you the likely charges or uncovered portions of the procedures. With the recent healthcare changes many insured families are also now subject to larger deductible amounts that must be paid by the patient, further increasing the level of frustration.
With that in mind we, at our practice, employ an entire staff of people solely to deal with the insurance companies on your behalf. We typically call your insurance and do our best to negotiate the pitfalls of the insurance process to save you the stress. A predetermination is sometimes, but not always, necessary to complete this process which can take an additional 4-6 weeks for your insurance company to review x-rays and documentation to determine your coverage. Please keep in mind that both of these processes are NOT guarantees of payment. Ultimately it is the patient’s responsibility to pay the amount due for any procedure performed. Prior to the procedure our office will in almost all cases provide you with a written estimate of our charges and the expected insurance reimbursement BEFORE the treatment is done. In rare instances the insurance company will tell our staff or you that you have coverage for a procedure and then once the claim is submitted, deny or refuse payment on the charges. We as a practice are here to help you try and minimize your out of pocket expenses if possible. Remember that we are in the same situation as you are in these cases. When the insurance company refuses payment our practice is left in the difficult situation of collecting money from our patients who did not expect to be responsible for these fees or in most cases fighting a lengthy battle with the insurance company to receive payment.
The bottom line when it comes to insurance companies, as with any business, is that they are in the business of making money. Your premium that you pay is a mathematically formulated fee to ensure that the insurance company is taking in more money than it will ever pay out. And despite our efforts on your behalf one of the ways that insurance companies hold onto that money is by denying claims. Here at Pottstown Oral and Maxillofacial Surgery our primary concern is providing our patients with the best possible care regardless of insurance coverage. It is, and will always continue to be, the patient’s decision on whether or not to undergo any procedure and it is ultimately the patient’s responsibility for the financial charges of that procedure.