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Joined: 9/8/2012(UTC)
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So I attended your course in NY a few weeks ago and I am trying to get our first pre-auth... when I called the insurance company they told me because her policy is an HMO policy and we need to do something else... do you know what we need to do.
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Guest!
It sounds like the insurer is likely referencing a gap exception request, or out of network exception request. This is a request to the medical insurer to allow the patient to utilize their in-network benefits at your practice as an out of network provider (because typically HMO plan only have in-network benefits available). Typically medical insurers will approve these requests if there is not already another practice within a "reasonable distance" who is in-network who can provide the service. The reasonable distance is typically set between about 30-40 miles - but could be higher or lower depending on your region and the insurer.
If you have the DentalWriter software, there is a sample gap exception request you can use the QuickLetter templates in any patient chart.
Hope this helps!
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