Often Dr Timmerman is asked about insurance coverage. While we strive diligently to help, often the insurance company does little to help. This is a good article from Medical Economics to keep in mind, although from a medical insurance perspective.
In dentistry, there is no such thing as a pre-authorization. The paperwork is called a pre-determination, but it is not a guarantee of payment. It is not unusual for something to be determined at full coverage, but when the files are submitted, payment is only partial, instead of full. Be aware of this!
Policies that require physicians to ask permission from a patient’s insurance company before performing a treatment negatively impact patient care, according to results of a survey by the American Medical Association.
The results showed 78% of physicians saying insurers use preauthorization requirements for an unreasonable list of tests, procedures and drugs.
More than one-third (37%) of physicians experience a 1 in 5 rejection rate from insurers on first-time preauthorization requests for tests and procedures, and 57% of physicians experience a 1 in 5 percent rejection rate from insurers on first-time preauthorization requests for drugs.
Nearly half (46%) of physicians experience difficulty obtaining approval from insurers on a quarter or more of preauthorization requests for tests and procedures and 58% of physicians experience difficulty obtaining approval from insurers on a quarter or more of preauthorization requests for drugs
These facts should shed some light into the use of preauthorization in the dental insurance industry. We will help you when it comes to gaining approval for dental procedures so you do not have to go through all the hassle of jumping though insurance hoops.