Category: Dental Insurance & Medicaid

The 135th General Assembly enacted legislation, Senate Bill 40, in 2024 that adds common sense fairness back to the dental insurance system. This new law prohibits dental insurance companies from dictating fees for services that the insurers do not even cover. Any new contracts entered into from Jan. 1, 2025 on, must be compliant with the new ... [continue reading]

As many of you know, starting in January of 2024, dental Medicaid reimbursements in Ohio increased on average by 93% per procedure. This across-the-board increase was the result of years of advocacy by the ODA and its member dentists urging policymakers to address the deficiencies in the dental Medicaid program. These reimbursement increases ... [continue reading]

No matter how diligent and efficient a dental office’s billing staff or dental insurance administrators are, there is always a possibility that their dental office may run into problems and/or misunderstandings with dental insurance companies or other third-party payers. These can range from minor annoyances to larger, more costly and ... [continue reading]

The Ohio Dental Association recently launched a new webpage on www.oda.org with resources on Medicaid and Medicare. Resources include: Information about incorporating Medicaid into a dental practice. A webinar created by the ODA with practical steps on how to successfully incorporate Medicaid into an Ohio dental practice. Information ... [continue reading]

Ohio’s Medicaid program provides publicly funded health care coverage to about 3 million low-income Ohioans (or about 26% of the state’s population), including children, pregnant women, older adults, people with disabilities and other adults. It is jointly funded by a roughly 65-35 split of federal to state tax dollars for most Medicaid ... [continue reading]

The most common concern that Ohio Dental Association member dentists have presented to the ODA’s Dental Insurance Working Group over the past many months has involved multiple dental insurance companies denying or deeming scaling and root planing claims not billable to the patient (i.e., the claim is denied and the dentist is contractually ... [continue reading]

Happy March! I am excited about seeing everyone at Leadership Institute March 21-22! If you haven’t registered yet go to https://www.oda.org/events-ce/leadership-institute. In this month’s column I would like to share some thoughts about Medicaid. Here are a few statistics to chew on as we go along: The population of Ohio is 11.8 ... [continue reading]

The Ohio Dental Association is often contacted by ODA member dentists upset with how an insurance company or other third-party payer has handled a dental claim. Some of these calls involve claim or prior authorization denials issued by a Medicaid HMO because the insurer determined the service in question was not medically necessary. As more ... [continue reading]

The Ohio Dental Association and LIBERTY Dental Plan have successfully worked together to develop practical plan criteria and medical necessity guidelines that dentists and LIBERTY can use to demonstrate the actual placement of a crown during the claim submission process for LIBERTY’s Medicare Advantage Plan. LIBERTY reported that it has ... [continue reading]

If you have been unsuccessful in resolving a dental insurance or third-party payer situation, you may want to consider submitting information to the Ohio Dental Association’s Dental Insurance Working Group (DIWG) to determine if the ODA has a role in addressing the matter. The DIWG is comprised of a dedicated group of ODA member dentists who ... [continue reading]