Policy manual for their Delta Dental of their state along with Delta USA the other PPOs have just one processing policy manual now I want to discuss about full coverage dental insurance with no waiting period what goes in that processing policy manual and some of the things that manual says first you’ve got to report all services.
So if I do crowns even though insurance only pays for the first couple crowns I’ve got to turn them all in if I do tooth whitening I’ve got to turn in the tooth whitening even though they’re not going to pay for it if they do veneers I’ve got to turn in veneers so all services for which you charge a fee are supposed to go in now.
Once you send that in they may come back and say we’re not going to pay for tooth whitening dr. Blair but we don’t like your $ Zoom fee here you’ve got to do it for what did they do to me they feed cap to me for non-covered procedures in other words insurance is not paying for it but they’re controlling my fee.
Can they do that yes the doctor might say well aren’t our state has passed a law against that roughly states have passed laws against this fee capping but guess what and this is so important there’s two kinds of patients that walk in your door there’s the full coverage dental insurance with no waiting period plan patient and that’s a patient that’s an individual that buys a policy.
That’s a small business Joe’s machine shop buys a policy that’s under the insurance commissioner of your state that’s under state law that’s under prompt payment laws that’s under the fee capping law.
But the problem is Howard is that the insured plan patient is about % of people % of people walking in the door our self-funded plan.