 Doctors:
Does United Concordia Make You See RED? May 31, 2000
Dear «PATFirstName»,
As you may be aware we have been having difficulties with
your insurance company. In February, United Concordia
mandated that all procedures be submitted for their approval
before any treatment was rendered. This was done as
a cost-cutting measure by United Concordia and not as a result
of problems with treatment outcome. We obliged them
by submitting a pre-authorization along with narratives and
radiographs. United Concordia's response to almost all
pre-authorizations was to deny treatment on the basis that
they did not feel it was necessary. They have also been
playing games when they do pay claims.
For 25 years my team has strived to deliver first class
treatment to all patients. United Concordia is trying
to dictate the treatment our patients receive, and we will
not waiver in our commitment to provide your family with absolutely
the best care. United Concordia's restrictions would
leave us in a position where we could no longer continue to
provide you with the dental care you deserve and have become
accustomed to.
Our relationship with patients like you is the foundation
of our success. We will continue to treat you like we
always have. We will still file your insurance claims
and help you maximize your dental benefits; the only change
is that the insurance check will go directly to you.
What this means for you is that you will pay our office and
your insurance company will reimburse you personally at their
current rate.
A major difference is that your insurance company can no
longer intervene between you and your dentist in making decisions
about what is best for you. Together we will discuss
your treatment options and decide what is best for you.
There will be no insurance middleman trying to save corporate
profits by denying treatment.
United Concordia will tell you that you have the option of
seeing another dentist. They will tell you that by seeing
a participating dentist it will cost less. They are
probably correct. It will cost them less. We suggest
you consider the long-term costs of allowing the insurance
company to determine treatment. Your employer has paid
for traditional (indemnity) coverage for you. United
Concordia has downgraded that purchase to a managed care policy.
We will only deliver top dental care to our patients; we will
not be restricted by allowance reimbursements that have not
changed since 1980. We realize that some of you will succumb to United Concordia's
financial coercion. We want you to know that our door is always
open. We have decided to sever our ties with United
Concordia, not our patients.
Sincerely,
Stephen J. Markus, D.M.D.
What can you do to help?
- Complain to your benefits management people that your
favorite dentist, one who has never had a complaint against
him with United Concordia, is one of several dentists who
are being unfairly targeted by them, and as a result you
cannot get needed dentistry done.
- If there is another page attached to this letter, please
sign it, photocopy it, and send it in the envelope
enclosed to UC. Then, if they do not follow through, please
follow up with them at the number we have provided on the
form you duplicated. Please document all conversations
you have with them on the back of the duplicate form.
Be especially cognizant of them trying to send you to another
dental office, and be indignant when they suggest that.
Ask them what is wrong with Dr. Markus? Be sure to
get the name of the person with whom you are speaking.
- We have begun plans to initiate litigation in conjunction
with other dentists who they have unfairly targeted.
The A.D.A. , Pennsylvania and NJ State Insurance Commissions
and State Dental Associations, the Second Opinion Utilization
Review Panel of the American Academy of Pain Management,
and other sources have become part of this problem, and
are trying to help us put an end to this charade on the
part of United Concordia. You might want to consider
sending your letter of protest as well. A copy of
the letter we sent to the ADA will be available on the internet
for you to download. Contact us for further information
on how to do so.
- Hound the insurance company with complaints about the
delay in your treatment caused by their failure
to authorize treatment.
- Please be patient with us. We are doing the very
best dentistry that we can, and will not compromise
our clinical decisions to save the insurance company
money.
- Have your benefits management people call our office
for further information.
«PATFirstName» «PATLastName»
«ACTAddress1»
«ACTAddress2»
«ACTCity», «ACTState» «ACTZipcode»
June 1, 2000
United Concordia Companies, Inc.
PO Box 898268
Camp Hill, PA 17089-8268
(1 800 322-0366)
Re:
Subscriber ID: Group:
( ) Pre D ( ) Actual Submission
( ) Date of Service _________
Relation to subscriber: ( ) self ( ) spouse ( ) child
Claim #:
Dear Dental Advisor:
As you are aware, I am insured by your company under the
policy numbers provided above. Dr. Markus has requested
authorization to perform
It is my understanding that this request has been denied
at least one time, and thus denied Dr. Markus permission to
proceed with the care for my teeth. In order that I may make an educated decision as to whether
I need to proceed with either another dentist or at my own
expense, I would ask that the complete file as to the work
product which resulted in the pre-determination being rejected
be sent to me within the next ten (1) days. Thank you
in advance. Respectfully,
«PATFirstName» «PATLastName»
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