Aschaffenburg & English

This is in response to the above complaint regarding a request by a patient's parent to provide a narrative report for removal of impacted wisdom teethThe parent states in his complaint thqat he has been told by his insurance company that is "reasonable and customary" for the surgeon to submit both xrays and a narrative reportThe patients father seems dissatisfied with the fact that even though appropriate claim was filed correctly the insurance company has refused to pay the claimFirst be aware that it is not" reasonable and customary" to file narrative reports for cases of wisdom tooth removalI have filed narrative reports for other rare and more complicated surgical proceduresHowever, wisdom tooth removal is so routine that insurance companies require the appropriate American Dental Association claim form, appropriate codes, fees and not always, but frequently, an xray in order to pay the claimIn fact, close to review of the patients insurance denial from states that " a narrative report or images (xrays to support the requested procedure are required." It specifically does not state that both both are requiredAs radiographs were sent on this claim, a narrative report should not be requiredIt is common that parents and patients are dissatisfied with their medical or or dental insurance claims processes and lack of appropriate reimbursement which results in higher out of pocket expensesAnd it is also common that the insurance companies frequently blame providers for not submitting claims properlyHowever, I can tell you that my claims processing person has years experience and submitted the claim properly in this caseUnfortunately [redacted] had decided not to pay the claimFinally, as a courtesy to Mr [redacted] I will be forwarding him a copy of this letter along with a letter stating that his daughters wisdom teeth were removed on a particular day and hopefully he will be able to file appeal with the company to achieve some reimbursementHowever, this is totally up to the patient and the patients health insurer as practitioners cannot be responsible for for what insurance company will or will not cover

Revdex.com: I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint # [redacted] I understand that by choosing to accept the business response that my complaint will be closed as resolved Regards, [redacted]

This is in response to the above complaint regarding a request by a patient's parent to provide a narrative report for removal of impacted wisdom teeth. The parent states in his complaint thqat he has been told by his insurance company that is "reasonable and customary" for the surgeon to submit...

both xrays and a narrative report. The patients father seems dissatisfied with the fact that even though appropriate claim was filed correctly the insurance company has refused to pay the claim. First be aware that it is not. " reasonable and customary" to file narrative reports for cases of wisdom tooth removal. I have filed narrative reports for other rare and more complicated surgical procedures. However, wisdom tooth removal is so routine that insurance companies require the appropriate American Dental Association claim form, appropriate codes, fees and not always, but frequently, an xray in order to pay the claim. In fact, close to review of the patients insurance denial from states that " a narrative report or images (xrays to support the requested procedure are required." It specifically does not state that both both are required. As radiographs were sent on this claim, a narrative report should not be required. It is common that parents and patients are dissatisfied with their medical or or dental insurance claims processes and lack of appropriate reimbursement which results in higher out of pocket expenses. And it is also common that the insurance companies frequently blame providers for not submitting claims properly. However, I can tell you that my claims processing person has 22 years experience and submitted the claim properly in this case. Unfortunately [redacted] had decided not to pay the claim. Finally, as a courtesy to Mr. [redacted] I will be forwarding him a copy of this letter along with a letter stating that his daughters wisdom teeth were removed on a particular day and hopefully he will be able to file appeal with the company to achieve some reimbursement. However, this is totally up to the patient and the patients health insurer as practitioners cannot be responsible for for what insurance company will or will not cover.

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
Regards,
[redacted]