Dr. Andrew Gazerro is currently the chairperson for the Council on Dental Benefits for the Rhode Island Dental Association and was directly involved in writing the nation’s first Non-Covered Services Law. He is a former Dental Consultant and maintains a private practice in West Warwick, RI.
In this episode we discuss:
– The game of Dental Insurance
– Narrative vs. Progress Notes
– Not being afraid to charge patients for services you provide
Tell us a little bit about your background in insurance
Back in the early 2000’s I responded to an add from one of the biggest dental benefit companies in the nation and basically would do what is called claim review. What that is, is benefit determination based on the processing policies of that corporation. They basically have guidelines that dentist who receive the claims, and you compare the information from the dentist to see if the procedures qualify to be paid for by insurance. We make a judgement call on whether or not to pay the claim based off of the information that the dentists send us.
So you’re the chairperson for council of dental benefits of Rhode Island. Can you tell me a little more about that and how you are helping the profession?
The way that my position came about was that we noticed that Delta plans were starting to put a clause in contracts that said if you have a patient through Delta, you have to continuously provide extended benefits for your patients even if they have exhausted their benefits for the calendar year. So I thought that wasn’t right. So I looked at the ADA response to it and they left us on our own. Because of my capacity as a previous consultant, I had the knowledge of how all of this works so with my legal council we set out and drafted a law that became the first non-covered service law in the United States. It essentially states that if there are no benefits available whether no coverage or they exhausted their benefits, that those patients now become fee-for-service patients and the practice has every right to charge for the services provided. Rhode Island was the first one to pass that law and 36 other states followed.
What advice would you give to dentists that feel like they don’t have to justify what they are charging for?
I think my best advice is, because you do. If you truly care for the patient and are trying to get them the benefits that they deserve, you have to justify everything and the simplest ways like photos and notations. Anything and everything that you can possibly send, send! In this digital age now, what is it costing you. You can send everything electronically. You have to get past this ideology of asking why you need to justify, and just send everything.
When we write narratives are there any magical tips or tricks to help us out?
Lets clarify these two. Your progress notes are a legal document. A narrative is a story. So if you want to increase the credibility of your claim review, instead of including a narrative, include your progress notes. Those are legal documents that cant be changed or made up. Document everything and make sure it is in your progress notes. What are some questions that the claims adjuster might ask, and what can i give them that will make it obvious of why I chose the procedure I did. If you really want to see an increase in the number of approved claims, you have to think about what you can send that will make it absolutely clear.