Sunday, February 20, 2005

Why are my crown claims being rejected?

The Huskin Group's consultants routinely receive the following question from our clients: "Why was my crown rejected by the insurance company? The lingual cusp was sheared off to the free gingiva!"

Our first questions is usually: "Did it look like the tooth needed a crown in the radiograph?"

The answer is often "Well, no but ...".

Our second question is then: "Did you include a narrative explaining the extent of the fracture and that it is not evident on the x-ray?"

Consultants are dentists too and are limited to evaluating what you send in. And if the fracture isn't evident on the x-rays, please tell them so so they have all necessary information to perform an intelligent claims review.

And finally, if the answer is "Yes", we ask, where did you write the narrative? Was it legible? Was it written in the notes section of the claim or scrawled some other place on the claim? And did you use red, black or blue ink? Companies are moving more and more toward OCR or optical scanning equipment to input their paper claims. These scanners are programmed to look in definite areas for additional information and some are color sensitive with regard to what writing they can detect. Red does not scan well.

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