I work for a dental office. I have been in the dental field as a front office receptionist for 2 years now. But I have only worked for my current employer for less than a year. My boss currently submits claims and sends out statements. I recently found out she is submitting limited oral evaluation with prophys to insurance. When I brought it to her attention she said "I can do that". Now Im not 100% sure if this is insurance fraud but im pretty sure, especially when the patients have to pay out of pocket for an exam that should be covered at 100%. Now I dont know what my next step is, it is very hard to work for someone who you think is being shady to her patients. I dont know what to do...i already tried bringing it to her attention, but according to her "she can do that". Someone please help me.
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I don't work in a dental office nor do I know that much about dental insurance. I have no idea what a prophys is. However, you have to explain what the benefit of her doing this. If the complete exam is payable at 100% by the insurance. But what she is billing requires a patient co pay. Isn't it better to get fully reimbursed by insurance than deal with trying to get money from the patients?
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