01 Oct Worst Claim Story October 2019
We had a patient that had a crown done on a molar, I believe #14. The office is VERY good about documentation, taking x-rays, taking intra oral photos, impeccable chart notes, etc. This tooth had a very large amalgam on it, if I remember correctly, I think it was like an MODB or something similar. A very large filling. The office also has an AMAZING intraoral camera, the photos are very crisp and you could clearly see multiple fractures in the tooth and the amalgam. The crown was denied, we appealed it 3 times and it was still being denied. We sent it in to the Colorado Insurance Commissioner and we got it paid!! The funny thing is, the insurance company, I think it was BCBS ended up not only paying for the crown, but they paid something like $175 in interest!!! It was a 2018 claim that did not get completed until 2019.
Dental Billing Tips and News for Pros; Edition #140