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Hi Vicki!
Great question. Although the medical insurer may have language in their coverage policies that indicates appropriate provider types for certain procedures/services, any denial you receive with the reason of provider type should certainly be appealed. The nature of the appeal should be that your doctor is working within his scope of practice, is trained for the service/procedure, and should not be discriminated against with that mind.
Hope this helps!
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Dr. Kusek does frenectomies on infants with laser so we submit to medical insurance. BCBS of North Dakota denied because it was performed by a dentist. We are not in network. Can this be denied solely based on the type of provider?
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