James Anderson

“We Don’t File Your Medical Claims…But You Can” – What Patient’s Really Hear…

I have had this question proposed to me no less than a hundred times in my career. By employers, by consulting clients and even by other billers. “Does it really matter if we file the patient’s medical claims?” or “We don’t know how to do that – can’t they just do it?”. My reaction is quick – yes, it matters. It matters to the patient and to the office.
        Your initial response to filing medical may be an aversion. It’s complicated, it requires knowledge your dental team doesn’t readily have and sometimes it doesn’t yield the results you’d like. More and more however we are seeing carriers lean towards requiring medical EOBs for surgical services. Some services are exclusively covered under medical such as dental accidents, TMJ treatment and sleep apnea appliances. Some patients won’t have dental coverage at all. So what happens when you don’t file to medical carriers:

  1.   Lower case acceptance. We all know patients are more likely to accept and go through with treatment when their out of pocket costs decrease. Not only filing medical claims but accepting the assignment can get the patient to accept treatment and may boost your revenue as the patient is more likely to do more treatment the more funds they have available.
  2.   High outstanding insurance. Have you ever had a dental carrier request a medical EOB? Have you then had to wait for the patient to file, followup and provide that EOB for you? Then you know exactly how long that dental claim can sit on your aging while you wait for that EOB. And before you say, we can bill the patient if the EOB doesn’t arrive in a timely manner, keep in mind that several states (such as Georgia) have laws on the books that if the insurance carrier will eventually pay you are required to collect from them and not bill the patient until you’ve done so.
  3.   Lower revenue. When you file both medical and dental you are permitted to collect up to your UCR fees. If you accept assignment for both you stand to gain more revenue than your average dental fee, especially if you are contracted on a fee schedule. By comparison, when the patient is filing, they will be the ones collecting the benefits and you will simply be collecting from the dental and billing them the portion they are responsible under the dental carrier.

While filing medical can be a hurdle at first once your process is streamlined your practice only stands to gain by your ability to bill, and get reimbursed from, your patient’s plans.


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