Sample Letters for Third-Party
Payers and Employers & Authorization Form
The Council on Dental Benefit Programs
has developed sample letters to send to third-party payers
and to send
to employers that address two common complaints
regarding explanation of benefits (EOB) language: denial
of payment because the procedure
was not considered "necessary" by the insurance carrier
and inferences that a dentist's fee is in excess of usual, customary,
and reasonable (UCR) fees in the community. These fees may be simply
be referred to as reasonable and customary fees and should be referenced
accordingly in the letters you send out. You may copy the text from
these sample letters onto your own letterhead, making modifications
where appropriate.
The sanctity of the dentist-patient relationship is an important
issue to keep in mind when you are contemplating communications
with others about your patients and their dental care. It
is recommended that you obtain the consent of your patient
if a letter is going to be sent to their employer. Why? It
is respectful of the patient's privacy, which is in keeping
with your ethical obligation to safeguard the confidentiality
of patient records. This will help you avoid running afoul
of applicable law. Example: If you are a covered entity under
HIPAA, you may need to obtain an authorization in order to
release a patient's protected health information to the patient's
employer. Because state laws vary, consult your attorney
or state dental association to determine whether state law
requires you to obtain consent before disclosing patient
information to an employer.
Please note: These sample letters and authorization form are
offered for your information and do not constitute legal
advice. Dentists must consult with their own attorneys for
such advice.
Third-party Payers Sample Letters
Employer Sample Letters
Contact
Information
ADA Council on Dental Benefit Programs
Telephone:
800-621-8099 or 312-440-2500
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