Let me simplify the question. I am a par dentist with only two insurance companies. It is my understanding that if I send in an EOB(predetermination) for a crown for a patient and it either gets denied outright or an alternate benefit is given for whatever reason and I have exhausted all the appeals, then I can enter a contract with the patient to do the crown and the patient will pay me for the crown anyway. The insurance company is ok with this as long as I have a written contract with the patient that they accept my treatment recommendation and now I can balance bill them.
My question is does anyone out there have a form letter that I can utilize for such a situation and obviously just make it my own on my own office stationary. Essentially a Sheet I can copy? It would be much appreciated. Thank you for the help.