James Anderson

When An Accident Is the Cause…

Most dentists don’t realize how frequently they see patients who have had an accident or trauma affect their dental health. Of course we are all familiar with the frantic calls from parents where boys were being too rough and it was all fun and games until someone cracked their tooth. And everyone has had that twenty-something patient who had a night out and came in with a sudden problem.
When a patient has had an accident often times their dental insurance isn’t enough to financially cover their treatment needs. Many times their medical insurance will carry an accidental rider for instances where teeth were damaged. It is important to check with the medical carrier for these benefits and determine whether they will be covered and if preauthorization is necessary. For accidents occasionally a carrier will allow retroactive preauthorization.
It is important to document several things for a successful accidental dental claim to be paid by medical. The first is to know the particulars of the accident. It makes a large difference whether the patient had a fall or was in an automobile accident. There are thousands of diagnosis codes that categorize what type of accident the patient had and it is imperative that the correct ones are assigned. Second it is important to gather any documentation regarding the accident. If the patient visited the emergency room or a doctor following the accident those notes can be helpful in establishing that the teeth were damaged in the accident. Third is thorough chart notes. It is important to note the patient’s pain following the accident, any challenges from the damage to the teeth and gums and the damage caused. Other health conditions that can affect healing are also important to note.
Patients are always grateful to a doctor who tries to maximize their insurance and reduce their out of pocket expense. They also may be more likely to do the optimum treatment (versus a less expensive, less desirable option) if they can avail themselves of medical benefits. Learning how to file simple but effective medical claims can not only boost practice revenue but make your patients happy that you care enough to go outside the mainstream claims process to ensure they get the treatment they need.


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