Dental Sleep Medicine Insider January 2015 | Page 9
LETTER OF MEDICAL NECESSITY:
WHAT, WHY, & THE BIGGEST QUESTION:
“HOW DO I GET ONE?”
LOMN. These four ominous letters have been the road
block for many dental offices, including my own….
Let’s face it, we know how dental insurance works. The tooth was broken, I diagnosed it, then I fixed it, now pay me, please.
Send in a claim with an X-ray and a short
narrative and it’s paid. Dental plans have
$750 to $3000 yearly maximums so the gate
keepers work hard to not pay claims, but
they know the faucet will turn off at some
point.
Lesia Crawford,
CEO, GoGo Billing
877-874-4646 ext. 1
[email protected]
GoGo Tip of the Month:
Send the letter and LOMN to
the primary care physician, the
sleep doctor, heart specialist or
any other specialist who has
had any involvement with the
patient’s diagnosis and/or treatment. Whomever sends it back
signed first - wins! You only
need one to give to the insurance gate keeper. Contact me
with any questions & have a
happy & productive 2015!
Medical plans are completely different
from dental plans. They have million dollar
maximums or frequently, no maximum at
all. Gate keepers are guarding that pile of
cash with their lives! Considering UHC is
currently holding 84th place at $80.96 Billion on the Forbes Global List, it’s obvious
they are doing a stellar job protecting that
gold like a dragon in a fairy tale. Now, if
every policy holder was running around getting 3D imaging and blood panels drawn for
every tummy ache they assumed was a tumor, UHC might not even get onto the prestigious Forbes list. To stop patients from
deciding what treatment they need based on
Google and WebMD, medical plans use preauthorizations to decide if the treatment or
testing is “medically necessary”. By getting
the prescription for treatment and Letter of
Medical Necessity (LOMN) proof is provided to the plan that the patient needs the oral
appliance, and we are playing by the rules.
Pre-authorizations are not a luxury, they are
a necessity and the LOMN is the most important piece of the puzzle for an approval.
www.DentalSleepSolutions.com
This magical letter is the key to unlock the
safe and get payment for the treatment you
are delivering. But wait! There is more! This
act of correspondence not only gets you paid
by the insurance companies, but also gives
you credibility and opens communication
with primary care doctors, sleep doctors, and
pulmonary specialists. You want as many
physicians aware of how easy you are to
work with and you want them to know their
patients will be treated with the utmost care,
compassion, and professionalism. Utilizing
patients’ benefits and minimizing out of
pocket costs can be more important. You
want the patient to get the root canal done so
you can fit the crown, right? So you refer to
the office that gets your patient treated and
sent back to you. The DDS who treats sleep
apnea for cash and doesn't play the medical
insurance game is equivalent to the specialist
who costs so much that your patient actually
gets mad at you for sending them.
While medical offices are as familiar with
the LOMN as we are with referrals for 3rd
molar extractions, they still want it to be
easy and take as little time as possible. DS3
gives you the tools to send letters introducing yourself as a skilled dentist treating sleep
apnea with an interest in treating mutual patients. It’s simple and with a couple mouse
clicks, it can be printed for mailing or transmitted via digital fax. Medical offices appreciate that the LOMN is already filled out just sign here and send back please.