INSURANCE COMPLAINT FORMS

“Your request has been denied”

During the thirty-plus years that denturists have been practicing in Oregon, consistent frustration has been experienced by many when it comes to working with a patient’s insurance provider, especially when their role is that of a benefits administrator who processes insurance claims for a company that self-funds their employees’ healthcare.  Denials for service pre-authorization and rejected reimbursement requests frustrate both denturists and their patients.  Even more important, the unjustifiable refusal to honor requests from legitimate, licensed providers has denied Oregonians access to services that are guaranteed in Oregon law.

While this situation is complex, and a once-and-for-all solution will require efforts on a national scale, a proven effective strategy for attacking this problem has been created and is introduced here.

With support from the Oregon State Denturist Association, you can apply this strategy and use the tools below to communicate with a patient’s employer, their benefits administrator and government agencies that oversee insurance activity.
Below you will find examples of resources that are now available on the OSDA website including:

• Step-by-step instructions for how to apply this strategy within your practice and
• Letter templates that can be used to communicate with a patient, their employer and the benefits administrator when service pre-authorization or reimbursement requests have been denied.

Simply save these template files onto your computer to access whenever needed.  Fill in the blanks with the appropriate information, print on your clinic letterhead, and put them in the mail with recommended enclosures.  And the OSDA can be there with you, following up and educating all concerned about denturism in Oregon.

Apply this strategy within your practice, and we believe you can successfully overcome unjustifiable obstacles to patient care, both now and in the future.

Please take a few moments to review these materials below and call either Joe Coss or Ron Farris if you have comments or questions.

Most sincerely,
OSDA President

Insurance Complaint Info and Letters
Overview – A Process and Resources for Filing Insurance-Related Claims
Sample Letter to Patient’s Insurance Company with State Statutes
Sample Letter to Patient’s Employer – HR Department
Sample Letter to Patient