understanding dental insurance plans & gathering medical necessity data

There is a seemingly never-ending tug-of-war going on between dental practices and insurance companies, with money as the rope. Insurance companies alter their plans constantly as they fight to hold onto as much money as possible, while dentists work on their end seeking as much reimbursement as possible to uphold their standard of care for maximum patient oral health. Dentists often have inadequate understanding insurance coverage and what is reimbursed versus their own clinical practices. The goal in learning these things is not to change the way one practices dentistry to fit the insurance plans, but to obtain solid working knowledge so that medical necessity can be easily determined and documented which, in turn, maximizes reimbursement within the scope of program contracts...
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