Board Certified Periodontist

72 – Preauthorization

Hi there. You are listening to the Perio Patient Podcast, a podcast for my patients and anyone else who cares to listen. Dr. Ben Young here, and I am a periodontist in private practice here in beautiful San Antonio, Texas.  

The title of this podcast is: Preauthorization 

This will be brief. Perhaps it’s just an excuse to say high. I hope you are doing well. 

Once in awhile we need to talk about insurance because most of the time it operates in the background – until we need it or expect it to cover something we think it should. 

A lot of people search for information about dental insurance as well and yet, they really do not understand it. And the reason it is difficult to understand in my opinion has a lot to do with how companies keep people from accessing their own information and consequently making informed decisions. 

So it’s absolutely logical for anyone to want to know what their insurance is going to pay for before they commit money for treatment. So, it makes sense for people to want to have a preauthorization. The problem is, kind of like the line from The Princes Bride, “I do not think it means what you think it means.” 

It’s fair to think that any word that has the word “authorization” in it implies that it is authorizing something – meaning that the insurance company committing it will cover the treatment it says it will in in the preauthorization letter that will come back.  

Not so fast buckaroo.  

There is some fine print on that page somewhere – and what it will tell you is that they can change their minds if they feel like it.  

So why submit for a preauthorization? Good question. Especially when you can find everything, they will report to you by making a phone call. Simply have your dental office provide you with the dental insurance codes. Call the insurance company or look the codes on their website and they will tell you whether or not they will cover the procedure and at what percent. Of course, there is always the assumption that you have met whatever annual deductible is required and you have not maxed out your insurance for that particular year.  

Some companies have changed what has classically been called “preauthorization.”  

Some call it a “pre-estimate” and others call it as “pre-determination.” 

I actually think these terms are a little more honest – because they are completely nonsensical terms. For example, you can’t estimate something before you estimate it. So, what does a pre-estimate do? And what is an estimate? Is it an accurate assessment? Nope. It’s a guess.  

Same with pre-determination. The real determination will come when the procedure has been completed and they get the paper work and then decide or determine what it is they will do.  

Oh, and one last thing. Some people like to call to find out what different dentists will charge for a particular procedure. That’s really no different than a pre-estimate. It’s a complete waste of everyone’s time because the only way to really know what something will cost is to have an examination. After this, you can certainly obtain the dental codes and I guess, if you want, you can call other dental offices and ask them what they charge for that particular code. Seems clever, but offices who will attempt to win you over because they are on the low-end cost-wise may not be the offices you want to have your treatment in. But don’t get me wrong on this to say that I think the most expensive treatment will be the best. The best treatment will come when you find people you trust AND you become a good patient. What’s a good patient? Someone who is involved in their own care, who asks reasonable questions, who is kind to everyone in the office, not just the dentist and finally someone who sees the big picture and the advantage of finding trusted healthcare providers and others who they will continue to see for many years if at all possible. Those who move around – because insurance changes – for example, often end up paying more for care. Rather than move away due to insurance, have a conversation with the office who has been supporting you care for many years. See if you can work out some way for you to be able to remain in their care. If you like them and they like you, trust me, most problems can be worked out. On the other hand, if you feel invisible or like just a number, trust me there are many great dentists out there. 

Well, that’s it for today.  

This has been The Perio Patient Podcast and I am still Dr. Ben Young. Thanks for listening.  

Thanks to all of you who are telling others to listen or look at my website. Lot’s of info there.  

Have a great day. Bye for now.