[ACEsthetics] New Post/Thread Notification: Dental Insurance: Friend or Foe?

Hello,

SpikeDDS has just posted in the Dental Insurance: Friend or Foe? forum of ACE Dental World under the title of Why am I having to appeal this?.

This thread is located at http://www.acedentalforum.com/forum/threads/2182-Why-am-I-having-to-appeal-this

Here is the message that has just been posted:
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Pt has MetLife insurance. We did 4 quads of S/RP and antimicrobial placement on all sites 5mm and above. Pt has generalized mod-adv perio. He presents with 6+mm probiongs on the following teeth: 1,2,3,5,12,13,14,16,19,20,30-32, ALL with BOP, and 4 5mm probings on #29 w/ purulence on 1 site and 4 sites w/ BOP. Two other teeth only have 5mm w/ BOP: 21 & 24. Clearest-cut case I have seen in a long time indicating placement of antimicrobials. Perio chart sent showing ALL of this. We hear back saying I need to write a narrative justifying the antimicrobials. WHAT THE HELL AM I SUPPOSED TO WRITE THAT HASN'T ALREADY BEEN SENT? I call and they say it MUST be appealed in writing. What the heck am I paying for electronic claims for? How the heck can they justify this denial? Of course, I am not allowed to speak with the very people who say that my information is incomplete. All I want from them is for them to tell me what information I need to clarify. I understand that they will not pay for the two teeth that have only 5mm pockets, since the policy only covers 6+. OK, fine. Then pay on the 6+ mm teeth! Why is it necessary for me to repeat what has already been sent? This is ALL just so they can delay/deny payment for appropriate care.

THIS IS CRAP! What can I do about it? Nothing?
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