Courtesy Billing Explanation: Botox for Vaginismus
DMT Insurance Billing Services, LLC – Diane M. Tremblay, Billing Specialist
Thank you for your inquiry regarding medical insurance billing of the Botox for Vaginismus procedure with Dr. Peter T. Pacik of Manchester, New Hampshire. Our mission at DMT Insurance Billing Services is to provide our clients with a high quality, professional medical insurance billing function where we can be proud of the integrity and timeliness of our claims and to offer superior customer service while always remembering to treat each client as we would want to be treated. Financial reimbursement is our goal for each and every client.
Our office will start with confirming eligibility of insurance, benefits and coverage along with confirmation of whether or not a pre-certification or prior authorization is necessary in order for benefits to apply. DMT Insurance Billing Services will also bill the claim, follow up on the status of the claim and initiate first and second level of appeals, if necessary, to get reimbursement from the insurance carrier.
DMT Insurance Billing Services is knowledgeable in acquiring “out-of-network” reimbursement for those clients who must go out-of-network for treatment for vaginismus. This applies to all insurance carriers to include PPO, HMO and independent insurance carriers.
This service is known as “Courtesy Billing.”
DMT Insurance Billing Services, LLC, offer services as follows:
1. A non-refundable fee of $75 is required to start the process that will include eligibility of insurance, benefits, pre-certification and/or a prior authorization for your treatment with Dr. Pacik. During pre-certification and/or prior authorization, it is always noted by the insurance carriers that these inquiries are not a guarantee of payment; therefore, our services are not a guarantee of reimbursement. We cannot control the decisions your insurance carrier chooses to make concerning your billing claim.
2. For an additional non-refundable fee of $125, DMT Insurance Billing Services will file your claim with the necessary billing codes and appropriate billing notes for proper reimbursement. This fee will include a “First Level of Appeals” process and, if necessary, a “Second Level of Appeals” that will involve your plea (your story) if you wish to add to the success rate of our final attempt in obtaining reimbursement.
If, after the first step, we find that your claim will not be reimbursed financially due to a high deductible, you may choose not to submit a claim to your insurance carrier (step two). However, it is important to note that if the claim is approved for reimbursement and gets applied towards your deductible, your deductible will then be reduced for your next billed claim for that calendar year. Proceeding with Step 2 is solely your decision if you have a high deductible.
Historically, professional billings for vaginismus-related procedures have been successful in obtaining some reimbursement to the patient. Insurance companies vary in how much they will reimburse. These claims usually require special care using notes acquired by Dr. Pacik’s office and billing accurate diagnoses and procedure codes and may take up to 30-45 days to process. Our services do include the follow-up status of your billed claim and you will be notified accordingly.
The following Billing Information will be needed to process your claim with your insurance carrier.
- Your name as it appears on the insurance ID card. If you are not the policyholder, please include the policyholder’s full name.
- Your date of birth and the date of birth of the policyholder
- Your full address and the full address of the policyholder
- Your identification number from your insurance card
- Best telephone number and email address to reach you.
- A copy of the front and back of the insurance ID card.
Our office will supply you with a copy of Diane Tremblay’s Welcome Letter and Billing Information Checklist, her phone number and her email address; just fill in the Contact Form and request Diane’s information in the Comment field.