Insurance Management FAQs

As a general dentist, one or more insurance carriers request that I submit radiographs in order to be reimbursed for periodontal scaling and root planing. However, periodontists are not required to do so. Isn't this discriminatory?

When a patient is involved in an automobile accident, does a dentist have any recourse in recovering the unpaid amount of a bill after the bill has been paid by an insurance carrier pursuant to Act 6 of 1990 (75 Pa C.S.A. ?? 1797)?

What can the American Dental Association, the Pennsylvania Dental Association or my local dental society do to stop insurance carriers from getting a foothold in my area?

Is an insurance carrier obligated to send an Explanation of Benefits (EOB)?

My patient is involved in an auto accident requiring dental services. Which insurance carrier is responsible for covering the injuries incurred in an auto accident?

Do insurance carriers get together to determine the level of payment they will make to dentists? Can dentists get together to arrive at an agreement as to what to charge for dental services?

I am new in practice and submitted a claim to an insurance carrier four weeks ago, but have heard nothing. Is this common?

I began work on a patient, submitted it to the insurance carrier and received payment, but the patient refused to let me complete the work. Is there an issue?

An insurance carrier will not pay for a particular service that I performed, but if I submit a slightly different code, it will be covered. Should I submit the code for the service that would be covered so that my patient can be reimbursed?

What are a dentist's obligations under an "Alternate Benefit Provision" (ABP)?

What factors should I consider with respect to participation?

I prefer not to submit original radiographs to insurance carriers. Is there an alternative?

I would like to consider participation with an insurance carrier and have requested a complete listing of their fees in order to make an informed decision. But the insurance carrier will only provide a partial listing of their allowances.

Am I required to collect coinsurance from my patients, or can I simply accept the amount that the insurance carrier pays as payment in full?