Question

Billie Joe McAllister presented with badly chipped porcelain on a crown today and, since you had time, you removed the crown and prepared it for a new one without prior authorization. You made a perfectly beautiful CEREC crown and captured before and after photos. Two weeks later the claim was denied. Why?

Option 1: Lack of photographic evidence
Option 2: Unauthorized procedure
Option 3: CEREC technology exclusion
Option 4: Failure to obtain preauthorization

Answer 1

The claim was likely denied due to the failure to obtain preauthorization for the dental crown procedure, despite having before and after photos.

Step-by-step explanation:

The student's question regarding why a claim was denied after providing dental care without prior authorization relates to the option of failure to obtain preauthorization. In medical and dental insurance policies, preauthorization is often required before performing certain procedures to ensure that the treatment proposed is covered under the patient's insurance plan. Regardless of the success of the procedure, or even the presence of before and after photos, without this preauthorization, insurance companies may deny claims. This is a common issue faced within healthcare professions, including dentistry, highlighting the importance of understanding and following insurance protocols.