Contributing Writer 
Dental Office Name
Dentist Name
Address
Patient Name: ___________________________ DOB: ____________Dear ______________________,
The above named person is a patient at our dental office. We need to consult with you regarding the following matter(s). Please review the checked areas below, write your recommendations, and return to our office as soon as possible to prevent delays in treatment. Thank you so much for your time and attention.
Does this patient require subacute bacterial endocarditis prophylaxis?
_______ Yes _______ No
This patient was unable to provide an accurate and thorough medical history. Please provide a full health history plus a current medication list.
Do you feel that the patient can tolerate the following procedures without serious or undue complications?
______ Yes _____ No Comments:___________________________________________________
Other consult:
Please fax this completed form to:
______________ __________________ ____________
Physician name Physician Signature Date
______________ ___________________ ____________
Dentist Name Dentist Signature Date
Response To Patient Billing/Insurance Maximum Concern
Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)
DATE
Patient name
Address
City, State Zip
Dear _____:
Thank you for sending me your letter with your insurance payment concerns.
I see this frustrating situation occurring more and more. Managed care is finding its way into dental insurance just as it has on the medical side. Dental insurance coverage is simply not going as far for patients as it has in years past.
One of the secrets that insurance companies have kept very quiet is the fact that they have not raised the annual maximum benefit in many years. When I started worked in my father’s dental office in 1976 most plans had a yearly maximum of $1,200 to 1,500; this could pay for extensive dental work, and was rarely used up. Now it can be used up on one procedure.
When a patient is referred to a specialist for part of their dental treatment, we try to estimate what our portion of the charges will be, and find out what percentage of that procedure is a covered benefit by your plan. We can usually estimate with pretty good accuracy, but it still leaves one factor out of our hands—the annual maximum. We have no way to monitor what other offices have billed, and what the insurance company has paid other providers. WDS has been a leader in electronic insurance processing and information transmittal, but it is still far from perfect.
There are literally hundreds of dental insurance plans, each with different maximums, percentages, covered procedures, and so on. Individual insurance plans often change details every single year. Patients need to familiarize themselves with the details of their particular plans, closely monitor their benefits, and keep us informed of their current status and any changes. Often the patients are better at keeping us up-to-date than the insurance companies are.
I would strongly encourage you to bring up your concerns with both the insurance company and your employer. The more people complaining of problems with coverage, the more likely it is to be improved. I am constantly expressing my concerns to the insurance companies. The employers need to know because they are the ones purchasing the dental insurance package for their employees. For the most part, employers can get any kind of coverage they want for their employees. In recent years, though, they are opting for the less costly packages, which means less inclusive dental coverage for the employees.
John, feel free to call me if you have any other questions.
Sincerely,
Dr. _______
Reply To Patient Billing Question
Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)
DATE
Patient Name
Address
City, State Zip
Dear Mr. Patient:
My bookkeeper gave me the letter you sent with your concerns, and I have looked into the billing. I’m still not sure where the confusion came from, as four teeth were marked as needing restorations at the check-up appointment, and four were done at the filling appointment. The only thing I can think of is that we said that three of them were cavities (the fourth was a broken filling but not decayed), or that three of them were in the same lower right area (a fourth was on the upper area).
I apologize for any misunderstanding. Although I can find no problem with what was billed, I have instructed my bookkeeper to credit your account for one of the fillings as a gesture of goodwill.
I asked my bookkeeper about your insurance coverage and she informed me that the plan you have is one of the lowest-coverage dental plans of the hundreds she works with. I would certainly encourage you to comment on this to your dental benefits coordinator. If enough people let them know their discouragement with their benefits, they might improve the plan.
I have no future plans to become a preferred provider for this particular insurance company. This is for the same reasons that many other dentists have not either—very simply, it encourages a lower level of care for the patients to save money. I am not willing to lower my standards. I am very proud of the quality of care my patients receive at our office, and plan to continue to maintain this standard.
My fees are right in line with the dental fees in the Seattle area, and I feel they are very fair, especially given the quality we provide. If the cost of your dental care is your primary concern, then going to a Preferred Provider would be beneficial to you. If high quality of care is just as important, or more important, then I encourage you to examine all aspects of your dental insurance plan carefully.
Feel free to call me if you have any other questions.
Sincerely,
Randy Otterholt, DDS
Billing Question, Patient Confusion
Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)
Date
Mr. Patient
Address
CityStateZip
Dear Mr. ______:
I'm sorry there is confusion over your bill. Hopefully I can help clarify the issue. As we have explained, we proceeded with your treatment as you requested at the time: we contacted your dental insurance company, they informed us of your current benefits, and we planned your treatment based on that information. However, we were not informed, nor do we have any way to know, that part of your yearly benefits were used up by dental treatment at a different office.
The financial responsibility for dental services lies solely with the patient. Dental insurance is a contract between the patient and their insurance company. Our involvement is only to submit a claim as a courtesy to help our patients. We do our best to assist patients in determining their benefits, but as you can see, the insurance company does not always provide us with accurate or up-to-date information. It is ultimately up to the patient to be fully aware and up-to-date on the status of their insurance at any particular time, and to pay for services rendered regardless of insurance coverage.
Please correct me if I am reading your letter wrong, but it looks like you are asking me to not bill you for $772.60. Billing the insurance company for one amount and then billing the patient for a different amount is insurance fraud. I know I do not want to be involved with insurance fraud, and I doubt this is your intention either.
Sincerely,
Dr. ________
Refund for Endodontic Treatment
Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)
DATE
Patient Name
Address
City, State Zip
Dear ___________________,
As we discussed at your recent appointment, we have attempted to save your problem tooth with a root canal treatment. Although root canal treatment has a high success rate, it is not 100%. Unfortunately yours was one of those that did not respond to the treatment.
I would like to return the payments that you have made to date for this endodontic procedure. Please find the enclosed check for $xxx.xx. Although many dentists do not do this, I am choosing to return your payments in order to maintain the good relationship we have developed.
As a reminder, I have referred you to Dr. ________, an endodontic specialist, for consultation about whether or not specialized treatment might help the tooth. Please do not delay this, as it will further decrease the chances of successful treatment.
-or-
As a reminder, I have referred you to Dr. ________, an Oral Surgeon specialist, to discuss removal of the tooth and possible implant replacement.
Sincerely,
Dr. _______
