Payment Options & Insurance Guidelines at the Raleigh Facial Pain Center
Our office chooses to focus our attention on you, your pain, and the management of your care. Thus, we ask that you cover the cost of services at the time of each visit. To help you with filing for reimbursement from your insurance provider, you will be provided with a ready-to-mail insurance form at each visit. We will also give you a Letter of Medical Necessity and a detailed examination letter for you to send to your insurance provider. We will send a copy of the detailed letter to your referring doctor and other professionals involved with your care. About 80 percent of our patients report they are reimbursed for Dr. Yount’s services by their insurance provider.
The staff at the Raleigh Facial Pain Center will work with you to achieve a balanced and pain-free lifestyle. We accept credit cards, flex spending cards, checks and offer CareCredit — a healthcare credit card that provides plans allowing up to 12 months of interest free payments. To find out more about CareCredit, click here.
Protecting Your Rights for Insurance Reimbursement
We recommend that you call the insurance company and say:
“I have been referred to a Board Certified Orofacial Pain Professional. I understand he is not in my network nor is there another provider with matching credentials. I would like to know what my plan covers.”
The response may be a simple ‘no problem you are covered’ or you may get any of the following negative answers. In assisting prior patients, we have gathered some helpful defensive facts.
Your medical plan may try to exclude TMJ: the word “TMJ” is not a disease nor should it be used to describe a disease, it is an abbreviation for the chewing system jaw joint. How can a medical policy exlude one joint and not the next joint? Insurance law 58-3-121 prohibits “discrimination against coverage of procedures involving bones or joints of the jaw, face, or head” and requires “coverage for the treatment of conditions of the jaw (temporomandibular joint), authorized therapeutic procedures shall include orthotic (use of intraoral joint protective appliance).”
TMJ is a dental problem: The dentist treats teeth, and the orofacial pain doctor treats muscles and joints of chewing system. The last time I look up in the dictionary the treatment of joints and muscles it was orthopedic science under medicine just as the treatment of knee would be. The US Court of Appeals ruling 1138-August 1990, ruled treatment for TMJ-related diagnoses as medical rather than dental, even if provider by training was a dentist. Two federal courts reviewed the scientific evidence and required payment under the medical plan.
We do not pay if you go out of the network: The insurance company cannot make you go to inferior care for any condition. If you have moderate damage to jaw joint, it requires special training: residency trained and board certified. The Insurance statute 58-50-30 (V2) states “policyholder, insured, or beneficiary shall have the right to choose the provider of the services.” Besides, when there are no network providers, what else can you do? You do not need teeth care, nor surgical tooth extractions, nor surgery for jaw joint that failed to provide pain relief and has been sidelined (look up AMOS on web and look at their guidelines for TMJ surgery-it must fail conservative therapy by orofacial pain doctor before surgery is even consider)
We have oral surgeons, pain specialists, etc. in the network: None of these are Board Certified in Orofacial Pain. The American Board of Orofacial Pain website (www.abop.net) lists the providers who are credentialed to treat the specific orthopedics of TMJ structures. Do not accept the bullying techniques of insurance companies economic blackmail. Stand up for your rights.
We are not in NC: All insurers who cover NC residents are subject to the statutes of the NC Department of Insurance — no matter where the company bases their operations.
The doctor’s office has to make this call: You are the insurance company’s customer. As such, you have the right to insist that they work with you. The insurance clerk with no medical training in orthopedics may not want to accept that you want the best care for your jaw pain through a ‘traditional office’ and not accept the “cattle medicine” that they want to pay for. They are appalled that anyone would stand up to them and participate in health care that is controlled by patient not insurance company. They think you are dumb enough to do what they tell you by money manipulation. So, if they tell you we have to call them to approve an examination to determine the source of your pain, they are lying to you. Until we see you, we have no information about your pathology that will help the insurer. Politely insist that they help you — even if you have to escalate your call and speak to a supervisor (who is on permanent vacation), so you go on to their supervisor.
You have a self-funded plan: This plan is administered by an insurance company, but the decisions on what is covered is made by a clerk at your business office (again w/ no training in health care or insurance contracts) at your employer. Contact your Human Resources Department and request assistance. Stand your ground for your rights. If they do not approve the medical care, they could be sued for practicing medicine without a license and/or for denying you access to medical care. These plans are managed by the US Department of Labor, not the NC Department of Insurance. The department of labor has no clue how to manage these out control insurance companies and they will not help. Please call and ask though.
It is very important to keep complete records. Note the date and time along with the name of everyone who speaks to you. Ask for — insist if you must — a call record number. This makes it difficult for the representative you reached to ‘forget’ to make appropriate notes in your files. You may need to prove that you called and what information you receive — this is especially important if you receive an authorization or other approval.
Contact us today for more information about payment options when treating chronic facial or jaw pain caused by TMD, headaches, toothaches, bite problems and more at the Raleigh Facial Pain Center.
Raleigh Facial Pain Center provides treatment for chronic facial pain and chronic jaw pain in patients in Raleigh, NC and surrounding areas, including Cary, Durham, Apex, Wake Forest, Chapel Hill, Greenville, Pinehurst, New Bern, Greensboro and even South Carolina, Tennessee and Virginia.