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Jaycee Brown

Jaycee Brown

Director of Communications

Reconstructive Dentistry Under Medical Benefits

By Stefanie Fario
It is a common story in every dental office. The patient that has been years between dental appointments. The patient with rampant decay and severely compromised dentition. The patient that it seems needs full-mouth rehabilitation and it is hard to know where to start. When most patients are lucky to have $2500 in yearly dental benefits prioritizing restorative procedures can not only be difficult but exhausting for a dentist who is just trying to help them get back on track with their oral health.
Now imagine that patient, in addition to their dental problems, has diabetes. Heart disease. Periodontal disease. Maybe they’ve been out of the country for a long period with no access to reliable care. Perhaps they were involved in some trauma or accident. Think about if you could tap into a financial resource with no care maximum that, with the right support and documentation, would cover their care at anywhere from fifty to eighty percent of UCR. That’s the world of reimbursement that filing medical claims will open up to your practice.
Let’s look at what it takes to file a good medical claim for reconstructive dentistry:

  1.       History. It is important to know your patient’s health and dental history. Any and all diseases and illnesses they have, when their last dental visit was, when their last medical visit was, any medications they are taking and patient’s overall mental state regarding their dental health.
  2.       Images and Radiographs. Pre-operative radiographs are essential to documenting the patient’s current dental situation as well as being useful for treatment planning.
  3.       Treatment Plan. Documenting the options a patient has and the course they have chosen to take can be essential for drafting future appeal letters should benefits not be initially awarded.
  4.       Referrals. If the patient is being seen because they are pursuing treatment for another disease or illness and need dental clearance then a referral or prescription from their medical provider can be useful in obtaining benefits.
  5.       Supporting Documentation. If the patient was involved in an accident or was out of the country on military, Peace Corps or religious missionary service having documentation of that fact is a compelling factor in obtaining benefits for a patient under their medical plan.


When dental offices think of dentistry under medical the first thing that usually comes to mind is oral surgery or TMJ. However many plans allow for restorative work if the right conditions and medical necessity is established. Offices with an established medical claims billing procedure, or who outsource to a third party billing company, have more to offer these patients than offices that strictly bill dental carriers.
Claims for crowns, dentures, implants, bone grafting and other major restorative procedures have been successfully billed to and paid by medical carriers. Even fillings can be considered if the right circumstances are in place. The next time a patient visits your office with needs that go far beyond their dental benefits think to look into their medical policy. Patients appreciate and value providers that go the extra mile to lower their out of pocket expense and provide them with reimbursement.
Dental Billing Tips and News for Pros; Edition #127

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