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With indemnity dental plans, the insurance company generally pays the dentist a percentage of the cost of services. Restrictions may include the co-payment requirements, waiting period, stated deductible, annual limitations, graduated percentage scales based on the type of procedure, and the length of time that the policy has been owned.
In Alliant's response to the Georgia insurance commissioner's inquiry, the company said an Aurora representative called Alliant at 4:04 p.m. the day of Mike Meier's appointment.
However, out-of-network medical billing has become common for privately insured patients even when they receive care in an in-network hospital, creating a substantial financial burden. [13] Surprise balance billing is when an out-of-network provider bills an individual for services that were not covered by the insurance plan.
Insurance companies often contractually require the dental offices in their networks to cover a full 80% of dental fees, leaving the patient to cover only 20%, known as the “co-pay,” out of ...
Payors evaluate claims by verifying the patient's insurance details, medical necessity of the recommended medical management plan, and adherence to insurance policy guidelines. [4] The payor returns the claim back to the medical biller and the biller evaluates how much of the bill the patient owes, after insurance is taken out.
The National Institute of Dental and Craniofacial Research carried out further research into dental care for minorities and found that black and Hispanic families in lower-income areas had much higher incidences of tooth decay. [12] Similar research shows that poor dental hygiene directly affects educational abilities and school attendance. [13]
In addition, payment to dental professionals is based on the CDT code(s) reported on the ADA Claim Form, so using the most current codes helps to maximize reimbursement and minimize audit liability. [6] In the near future, dental professionals will be required to use diagnosis codes in support of the procedures and services they provide.
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