Insurance Bullying and

The EVIL EMPIRE (Insurance)

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  • Dr. Marc Goldman

    Ironic that you just sent this out. I have been a periodontist for 34 years. Let's say, 90% of the claims are processed without a problem. We always send pocket charting and xrays electronically so we have an NEA attachment number. Yet, we are still told they NEVER GOT IT. Now the game they play is that any appeal has to be mailed in with all the original documentation even though they have it already. The insurance carries tell you they have 90 days to reply. Like you mentioned more time wasted on the phone tracking these appeals.

    The other day, I got a denial for crown lengthening from Delta Dental of NJ. Not because we didn't send the appropriate documentation but because of this policy statement: "Crown lenghtening is approved when the caries or fracture is BELOW the crest of the bone." Just read that statement again and realize that situation rarely if ever exists. In cases where that happens, it is more likely to extract then remove that much bone to crown lengthen.

    I went on my emails and there was a Delta Dental email with the COOs e-mail. I emailed him with this absurdity on Saturday at 8am. I was shocked to get a call back by 9am, on that Saturday! He really could not defend this at all. As of now, he was "looking into it". I will update you with his response but the point is get to the top people.

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