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.