The Insurance Game Of Risk
The reason dental is separate from medical is that the nature of the risk is fundamentally different as is the deferability of the care, says Dr. Adam C. Powell, president of Payer+Provider Syndicate, a management advisory and operational consulting firm focused on the managed care and healthcare delivery industries. If youre having a heart attack you’ll go to the ER right away. Dental problems can often wait and unfortunately often do. The problem may deteriorate, but often its not necessarily life-threatening.
Yes, dental problems often do wait. Mine is waiting until my next paycheck . But the argument that dental problems are less severe than medical ones doesnt quite hold up, not when you look at the numbers of ER visits for which dental-related problems account.
More than 800,000 annual ER visits arise from preventable dental problems, says Dr. Allena Willis Kennerly, an orthodontist. Dr. Glassman adds that this year alone 50,000 people will be diagnosed with oral cancer, adding, Probably 10,000 of those people will die, but these are things that if caught really early can be better treated, before they spread and metastasize.
How To Claim For Everyday Medical Expenses
Simply download our Laya App or submit a claim through your Member Area. You can now submit your claims for everyday medical expenses through the app or online at any point during the year – 24 hours a day, 7 days a week. It is really easy to use. It works by allowing the main member on your policy to take a photo of your receipt using a phone and submitting it through the App.
Follow these simple steps to make a claim using the Member App or online through Member Area.
We will only pay fees and charges for treatment, services and facilities that are reasonable and customary and in any event only up to the limits shown in the Benefit Table. By reasonable and customary we mean that what you are charged for and how much you are charged is not more than what the majority of our other members of the schemes are charged in Ireland for similar treatment services or facilities. Should you wish to find out the reasonable and customary amount for a service, please contact us and we will be happy to advise you.
Step 1: Collect Your Itemized Receipts
To file a claim you need to first obtain an itemized bill from your doctor or medical provider. This bill will list every service you received along with the cost and a special code the insurance company will need to pay your claim. Getting these receipts is relatively easy simply call your provider and let them know you are filing an insurance claim. From here they should promptly send your itemized receipts after providing a few pieces of information, such as your full name and date of service.
Submit Your Claim In Person
You can drop your claim off at Johnsons Richmond Hill location for processing, Monday to Friday, from 8:30 a.m. to 4:30 p.m. , excluding holidays. Once your claim is processed, your eligible reimbursement will be deposited into your bank account. If you are not signed up for direct deposit, your eligible claim reimbursement cheque will be mailed to you.
95 Mural StreetRichmond Hill, ON
Preparing To File Medical Insurance In A Dental Office
How To Bill Medical Insurance For Dental Procedures
Theres no doubt that oral health impacts overall physical health. But that doesnt guarantee the ease of how to bill medical insurance for dental procedures.
Its a more complicated process than whats implied with an off-the-cuff statement like, Just charge it to medical! Even so, there are more dental procedures than you might be aware of that can actually be covered with a patients medical insurance.
Your Provider Submits The Claim Directly
Pharmacy claims: Present your benefits card at the time of purchase and your pharmacist will send your claim electronically. If your pharmacist is unable to submit your claim electronically, the pharmacist can call the pharmacy helpline at .
Dental, paramedical and vision offices with the ability to submit electronic claims can submit your claim for you directly. You may be asked to pay for the service upfront, depending on the practitioners arrangement.
Making A Benefits Claim
The University health and dental coverage is provided through Sun Life. Claims for reimbursement of expenses are typically submitted in the following three ways:
1. Online Submission of Claims through Sun Life Member Services
Expenses can be submitted on-line using the . To learn more and register for the on-line service visit the Sun Life Member Services page.
2. my Sun Life Mobile App
As a Sun Life group benefits plan member you can submit a claim, submit a copy of a receipt by snapping a photo, view claims paid within the last 90 days using my Sun Life mobile app. Download the app from or the Apple App Store.
3. Completing a Paper Form
Expenses can be submitted by completing the respective claim form. All claims for expenses must be accompanied by original receipts, supporting documentation if required and/or the Explanation of Benefits form if your spouse’s plan has paid a portion of the expenses. Specific claim information is outlined below. Coverage is provided through Sun Life using the contract number 25379. Make a copy of the claim along with copies of the original receipts for your records. Mail the signed form, with your receipts to the following address:
Sun Life Assurance Company of Canada PO Box 2010 Station Waterloo Waterloo, Ontario N2J 0A6
Submit Your Claim Online
You can submit through the online claims portal. You will receive a confirmation number, and your claim form and receipts will be filed in the Filed Plan Benefits folder in the Communications Centre. For audit purposes, original receipts may be requested at any time. Please keep your receipts for seven years. Once processed, an Explanation of Benefits statement will be filed in the Plan Benefits folder in the Communications Centre.
When You Purchase A Prescription Drug:
- Present your benefits ID card to your pharmacist.
- Your pharmacist will use the card to verify your eligibility and drug coverage, and to apply any deductibles or coverage limits.
- You pay only for fees not covered by your plan and receive a printed explanation of benefits.
- You do not have to fill out any claim forms or wait for reimbursement. It’s all handled on the spot.
- Pharmacies that recognize your benefits ID card are also linked electronically with the provincial drug benefit plans. The pharmacist will know how much your provincial plan will cover, and how much you can claim under your health plan.
How To Set Up Direct Deposit For Your Claim Payments
Claim payments can be deposited directly into your bank account. Submit a VOID cheque to our insurance Service Administrator, and all future payments will be deposited to your account. Contact the Service Administrator at or for more information. Use the same bank account for direct deposit as you use for premium deduction. If you do not choose direct deposit for your claim payments, youll receive a claim payment cheque by mail.
Who Are Eligible Dependents
Under most circumstances, the term “child” includes:
- Your natural or legally adopted child.
- Your spouse’s child if living with you.
- A child for whom you are the legal guardian and who is wholly dependent on your for support.
- During the period of probation that precedes adoption, the child you are adopting.
- Any child described above must be unmarried, less than 21 years of age and wholly dependent on you for support. You must also have custody and control of that child.
- Your unmarried child under 26 years of age is also eligible, if he or she is wholly dependent on you for support and is a full-time student attending an educational institution.
- A child who is mentally or physically disabled and wholly dependent on your support is also eligible beyond age 21. Proof of the disability must be submitted within 31 days after the child reaches age 21. The form Application for Health/Dental Coverage for Overage Disabled Dependant Child must be completed in part by Human Resources and then by your child’s treating physician. Submit the form directly to Manulife Financial for review. Manulife will send you written confirmation of the results of their review.
For purposes of your benefits plan, your “spouse” is:
NOTE: Under the Quebec Act respecting prescription drug insurance, you and your eligible family members under age 65 must join the McGill Supplemental Health Plan if drug coverage not provided under another group insurance plan.
Submit All Your Claims And Attachments Electronically
Use Provider Tools forfree real-time claims with digital attachments and pre-treatment estimates. Youll see Delta Dentals payment and the patient portion when the claim or pre-treatment estimate processes, often within moments . Heres all you need to do:
- Register for your secure, free Online Services account .
- Log in.
- From the Provider Tools screen, transmit claims, digitized attachments and pre-treatment estimates with either of these tools:
- Submit Claim transmission is quick and efficient.
- My Patients your current patients are listed here and we add new patients as their claims are processed. Patient information is automatically entered on your pre-treatment estimate or claim.
You can also useFastAttach®, a service available through National Electronic Attachment, Inc. , to electronically transmit digitized x-rays, periodontal charts, Explanation of Benefits documents, photos and narratives.
If you are not submitting claims electronically, talk with your practice management system vendor about activating your systems electronic claims component.
Delta Dental and its affiliate companies use MetaVance Benefit Administration Software as the claims editing software product to provide timely and efficient adjudication for dental claims. This software helps our enterprise streamline many interrelated systems and processes, as well as increase functionality for the benefit of our dentists, enrollees and clients.
How To Successfully Bill Medical Insurance For Dental Treatment: An Interview With Laurie Owens Of Devdent
We recently hosted Laurie Owens, the Director of Medical Billing at Devdent for an online webinar. Her discussion about how dentists can utilize medical billing was so impressive that we decided to revisit the topic with her for our blog. Laurie says, Medical billing for dental procedures isnt just about maximizing reimbursement for patients; its about creating more value for your practice by treating the patients whole health.
Laurie has extensive experience in the dental industry. She worked as a treatment coordinator for a dental clinic for many years. What set her apart was her expertise as a medical biller. Laurie is a Certified Professional Biller and holds certification as a Certified Professional Coder . After the owners of the clinic retired, she joined Devdent, where she now educates dental practices on medical billing while also continuing to bill medical for 6 dental practices.
Laurie says there are several compelling reasons why your practice can benefit from medical billing:
Its Not About What Procedure You Do, Its About Why It Needs to Be Done!
Instead of focusing on what you can bill for, Laurie encourages dental practices to find out why the procedure needs to be done. If you can document medical necessity, even veneers can be a covered service, explains Laurie.
Two Top Conditions to Bill Under Medical
With The Right System You Can Help Your Patients Get The Most From Their Insurance Coverage
Your patient relationships will improve as you become their advocate for maximizing their insurance provisions. Planet DDSs Denticon Dental Practice Management Software helps you standardize those systems that help you assist your patients with their insurance benefits.
Ask Your Dentist To Submit Your Claims Directly To Manulife
When your dentist submits your claim directly to us, all you have to do is show your identification card to confirm that you’re covered for the services your dentist provided. If your dentist does not submit your claim directly to us, you must send us the dentist-completed standard dental claim form approved by the Canadian Dental Association.
Is Your Treatment Medically Necessary
The proposed treatment must be medically necessary and satisfy the criteria in our schedule of benefits for conditions of payment, including clinical indicators. Please check with your clinician to ensure you meet the relevant clinical indicators for your planned procedure.
All claims are paid in accordance with our scheme rules and table of benefits.
Need Help With Repairs
Choosing a Johnson-approved guaranteed repair facility means:
- You get a quick estimate & repair from a trustworthy supplier
- We handle all the details
- Well guarantee the work as long as youre insured with us
- Youre back on the road sooner
Ask your claims adjuster for a referral or check out the list of facilities.
E Provider Claim Verification Program
As part of the NIHB program’s risk management activities, Indigenous Services Canada has mandated its claims processor to maintain a set of pre-payment and post-payment processes, including claim verification activities.
This function incorporates the review of claims against records to confirm compliance with the terms and conditions of the NIHB program. If under any circumstances it is found that a provider has inappropriately billed the program, claim payments will be recovered; either by direct payment from the provider or withheld from future provider claim statements.
Detailed information about claim verification procedures and of providers are included in section 6. Provider Claim Verification Program of the Dental Claims Submission Kit available at Express Scripts Canada.
Electronic Encounter Forms For Deltacare Usa
You can save time and money while helping the environment by electronically submitting your encounter forms to DeltaCare USA.
- Saving money by eliminating printing, copying and mailing costs.
- Saving time by submitting electronic encounter forms daily, which can eliminate the need to spend more time running monthly reports.
- Receiving prompt notification of any invalid data, allowing you to make the necessary corrections and re-submit right away.
- Receiving reports of all successfully transmitted encounter forms, reducing follow-up on unpaid submissions.
DeltaCare USA’s payer identification number for encounter forms is DDCA3.
Step 2: Complete A Claim Form
A claim form is the document that tells your insurance company more details about the accident or illness in question. This will help them determine if the expenses you are claiming for are covered under your insurance plan or not, so the more information on this form the better. Keep in mind that each form should have instructions for completing the form and directions on how and where to send it, but if you have questions simply contact your insurance company.
Typical sections of a claim form:
- Personal information like your name, address and date of birth
- Insurance information such as a policy and group number
- Reason for your visit including background information about your condition
- Provider information including the doctors name and address
- Out-of-pocket expenses that you have already paid
The Barbaric History Of Dentistry
Despite it being a plainly medical issue, oral health has always been an outlier. Until the 1800s, dentistry was the domain of barbershops, practiced in the same chair and usually by the same guy who shaved your beard.
How would you feel if you went to your hairdresser and they pulled your tooth or lanced your abscess? asks Dr. Glassman.
Its so bizarre and frightful an image that its almost comical, but the history of our teeth and jaws being treated as something as incidental as our hair and nails still haunts us.
Dentistry has always had a disconnect to medicine, says Dr. Michael Tischler who specializes in reconstructive dentistry and the implant editor for Dentistry Today. In 1840 dentistry was proposed as a medical specialty to the University of Maryland in Baltimore and rejected.
We may have since greatly evolved in how we regard and understand dentistry, but we havent embraced it as a primarily medical issue; if we had, it would be covered under medical insurance, or at least, things like a root canal would be, because if you need a root canal and dont get one, you that lead to hospitalization. It is rumored that Queen Elizabeth died from blood poisoning as a result of an untreated tooth infection. That was a long time ago, but hey, it happens.
Print And Mail Your Claim Form
To print and mail your claim form, log in to My Account; choose the Plan Documents tab, then Forms. Next, select the appropriate form for your claim . To have a claim form mailed to you, call Member Services at the phone number on the back of your member ID card. Once you have your claim form:
- Complete and sign the form.
- Attach the required documentation.
- Mail everything to us according to the directions on the form.
* Pharmacy and vision out-of-network claims must be submitted using the paper claim form and by mail as described above.
Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the shared business name of CareFirst Advantage, Inc. and CareFirst Advantage DSNP, Inc. CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is the business name of Trusted Health Plan , Inc. In the District of Columbia and Maryland, CareFirst MedPlus and CareFirst Diversified Benefits are the business names of First Care, Inc.
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Electronic Solutions For Easy Claim Submission
Want to get paid faster? Submit your claims electronically! You should:
While we encourage you to submit all claims electronically, if you need to submit a paper claim, Review our paper claim Tips
Submit your attachments, such as X-rays, electronically using FastAttach® by National Electronic Attachment .
Our guidelines explain when we require attachments.
Extended Health Care Claims
When completing paper claim forms, you will need to include the policy number and your employee identification number. The policy number for extended health care and dental claims is 57130. Out-of-country claims are processed under 325156.
For all extended health care expense claims except prescription drugs:
London Benefit PaymentsPO Box 5064 Station BLondon ON N6A 0C4
You may be able to submit certain claims online through GroupNet.
Supplementary Health And Dental Insurance Plan
The Supplementary Health and Dental Insurance Plan extends coverage beyond what is covered by UHIP or OHIP. There is no overlap of coverage between UHIP and supplementary health insurance. Supplementary insurance plans are separate from UHIP.
Supplemental Health and Dental Insurance covers prescriptions, a portion of dental and medical expenses when prescribed by a doctor, and provides travel insurance when outside of Ontario and Canada. Students should automatically be enrolled in Supplementary Health and Dental Insurance Plans as part of their tuition, and can opt out if they have alternative coverage.
If you are an undergraduate student, the supplemental health plan is provided by the Students’ Union and if you are a graduate student, it is provided by the Graduate Students’ Association. More information about services covered and making a claim are available on the respective pages.
Tips And Information About Your Claim Submissions
- Submit your claim as soon as possible, so you dont forget. All claims must be submitted no later than the end of the calendar year following the year in which the expenses were incurred.
- Claims for items will apply toward the maximum in the year the item was paid in full. Claims for services will apply to the maximum in the year the service was rendered.
- Keep copies of your receipts. Photocopies of receipts are acceptable. Cash register and credit card receipts are not acceptable. File your receipts after youve submitted the claim and keep them for at least seven years.
- Receipts must contain the patients name, the vendor or providers information, the date of service or purchase, a description of the item purchased and a breakdown of charges. Please note that the patient account statement does not contain the information required.
- If a plan is cancelled, all claims must be submitted within 90 days of the cancellation date.
Determination Of When Services Are Rendered
For payment to be made, services must be completed. Services are considered to have been completed on the date services are performed. Services related to the preparation, supplying or installation of prosthetic or orthodontic appliances, inlays or crowns, or other services requiring more than one session are considered for payment only after insertion or completion.
Your GHI coverage may become effective or terminate while treatment is in progress. GHI will make payment only for services actually performed while coverage is in effect.
How To Submit An Insurance Claim
Straight, simple and to the point five easy steps to help you efficiently file a healthinsurance claim.
When handing over your insurance ID card is not enough to guarantee direct billing, its important to know how to submit a claim to your insurance company. This process can reimburse you for any visits youve paid for out-of-pocket and ensure your medical bills are paid as promptly as possible.
How To Claim For A Visit To Hospital
The majority of these claims are settled directly between us and the hospital so you don’t usually need to submit an In-patient claim form. However we have outlined some useful information below should you need it:
Step 1. If you are referred by your GP to a Consultant, let them know that you have private health insurance.
Step 2. Once you have the details of the hospital, Consultant and procedure code, please contact one of our customer service advisers on 021 202 2000 to check your cover.
Step 3. If you then need to go into hospital, please have your membership number with you – this can be found on your digital membership card on the Laya App. You will be asked to sign a claim form in hospital.
Step 4. The hospital then sends us the bill and in the majority of cases we settle these bills directly with the hospital. We will then send you a letter which will explain what has been paid on your behalf and to whom.