06 Nov Worst Claim Story— November 2018
A Patient came in with tooth #8 fractured at the MIL cusp after he got into a drunken fist fight. The doctor proceeded with restoring the tooth with a full porcelain crown. He had no other existing restorations. The insurance denied the claim for no x-ray. I contacted the office and asked about the x-ray, thinking I had overlooked it or maybe it was located somewhere else. The doctor responded and said he didn’t take an x-ray or photo because it was very evident that he needed a crown. We sent in a detailed narrative and the insurance still denied the crown. At this point I am racking my brain on how to get this paid. Then I thought of an idea. I called the office and asked them to contact the patient and see if he had taken a selfie with his broken tooth. Yes, he had! We sent the selfie in and the claim was paid.
Account Executive, eAssist Dental Solutions
Dental Billing Tips and News for Pros; Edition #129