Dealing with Dental Insurance Consultants

Accuracy and Completeness

If you’re replacing a prosthesis, indicate that fact on the claim in the proper section along with the date of insertion of the previous appliance and the reason for replacement.

A narrative is necessary here if reasons for replacement are not evident on the x-rays: decay, open margin, etc. (Remember that benefits for replacement are not available just because the prosthesis is “old” or “cosmetically unacceptable”. It must have a loss in functionality). If you didn’t originally place the prosthesis, find out its insertion date.

You’ll want to confirm that it’s eligible for replacement based on the frequency terms of the patient’s contract so there are no financial misunderstandings.

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