Here is a helpful guide for steps that should be taken before coming in for your first office visit with us. When you call our office to schedule, we try to review all of these steps with our patients. We find that it is much quicker to give our patients this information in a written form so that they can be prepared before we ever speak with them. This process can be quite complicated and confusing. We find that following these steps will speed up the process and eliminate extra time and phone calls.

Important Information:

All patients that come in to our office for appointments will pay out of pocket for the fees rendered. It is a requirement because we are never certain if insurance will pay for any of the services that we render here in our office. We will always let our patients know all of the fees and possible charges prior to their visit so that they are aware and prepared for all costs.
 
Our patients must pay at the time of service due to the fact that we are unable to contract with your insurance to be providers. Dr. Spencer and Dr. Murphy are dentists treating TMJ/TMD, which is not considered a dental condition, but instead is considered a medical condition. For this reason we are unable to contract with the medical portion of our patients’ insurance. We will not be a listed provider for your insurance and are considered an out-of-network provider.   

Before Coming In
To Do List:

• Referral: Get a referral from your doctor’s office if they didn’t already give you one.  Bring that referral with you, or have them fax it over to our office. Even if the doctor simply says that it is ok to come here for treatment, it will be enough for the insurance. It is helpful to have a referral when working with insurance because insurance companies will be more willing to reimburse if we have sufficient proof to show these symptoms.
• Insurance Information: Call your insurance or search through your benefits booklet to see if your insurance will cover your office visit with us.  Here are some suggestions of questions to ask your insurance:
• • Ask if there is an exclusion for the treatment of TMJ and what would be covered as you come in for treatment.
  • Ask if there are any prior authorizations that will need to take place before coming in and what you will need to do. Most insurances do not need prior authorization before your first appointment. (If there are authorizations that need to be done see Prior Authorizations below.)  If prior authorizations are needed for the appliance or for other office visits, those should wait until after the first appointment.
  • Find out the amount of deductible you have left to pay, if you would like to know.
  • Find out which procedures and office visits would be covered and at what rate (see list of procedure codes below). 

Call our office to schedule an appointment. We will ask about your symptoms and how long you have been experiencing them.  We will try and get you in to see Dr. Spencer or Dr. Murphy as soon as possible.   
 
Prior Authorizations

Many insurances will require prior approval with them before the patient comes in to our office for treatment. And some patients will want to have an estimate for the amount of out-of-pocket expense they will have. Each insurance and each policy is different. We will try to make this helpful, but it can be confusing since each individual insurance will have their own criteria to meet.


When a Prior Authorization is needed:

Ask your insurance everything that is required to initiate the prior authorization.

• Ask what you will need to submit to them.
• Ask specific details if you are not certain sure what they require.
• Ask for the specific fax number to fax it, the mailing address, a contact name, their direct phone number and extension, how long the processing time is, what department to direct it to and a reference number (they might not have one assigned yet).
• Mail everything that your insurance has requested. Make sure that you have the correct address and contact information. 

                   Things commonly requested:

• Referral, reason you are coming to us 
• Clinical/chart notes, office records--ask us
• Information on the Appliance (s)--We can give this to our patients upon request.
• Letter of Medical Necessity, Letter of Explanation--we will provide these for you upon your request  

After everything is mailed or faxed, you will want to follow up on it.  If it is faxed, give them a day or two. If it is mailed, give them a week or more. If they didn’t receive it, then verify all of the contact information and send again. Once they receive everything, they should give you a reference number and send it to be processed.  Some times they will need additional information from us. If this is the case, they will generally send us a records request.  Have them give you a time frame for when you will receive an answer.  

Any questions or concerns, please call us!!!