Every month, volunteer member dentists who serve on the Ohio Dental Association’s Dental Insurance Working Group consider questions, concerns and complaints that are submitted by ODA member dentists relative to dental insurance. A common theme of many of the submissions involves problems associated with denied claims that could have been ... [continue reading]
Representatives of the Ohio Dental Association and the Dental Care Plus Group (DCPG) met in mid-December to discuss recent changes that DCPG had made to its crown and core buildup claim review criteria. The changes, which went into effect on Oct. 1, 2019, caused much concern and controversy among many dentists in the Cincinnati area.
DCPG is a ... [continue reading]
The Ohio Dental Association has recently been contacted by a number of ODA members who have received a notice from an insurance company that they contract with concerning their participation/non-participation in Medicare. The notice has led many dentists to draw incorrect conclusions regarding both its intent and their options to respond to ... [continue reading]
The Ohio Dental Association often receives questions from member dentists regarding whether they are able to receive reimbursement for services when the patient does not complete the prescribed course of treatment, e.g., a tooth has been prepped but for whatever reason the crown does not get seated. Patient non-compliance, benefit plan changes and ... [continue reading]
The Ohio Dental Association's Dental Insurance Working Group and ODA member dentists throughout the state have identified an apparent trend when it comes to dentists' interactions with dental insurance companies and third-party payers. Many payers don't seem willing to simply take the dentist's word on some dental insurance claims that certain ... [continue reading]
To have a dental claim denied that the dentist believes is appropriate and necessary treatment is bad. To have a claim in the same situation disallowed or deemed not billable to the patient is horrible.
Claim denials typically result from limitations or exclusions contained in the patient’s dental benefits plan, e.g., the patient has ... [continue reading]
It appears the Ohio Dental Association has played an instrumental role in overturning a decision to terminate the participating provider status of a number of ODA member dentists with one of Ohio's Medicaid HMOs.
Earlier this year numerous ODA member dentists received correspondence from DentaQuest stating that their offices would no longer be ... [continue reading]
Ohio Dental Association members continue to address situations where an insurance company or other third-party payer wants to recover funds from reimbursement amounts they have previously made to the dentist. The causes for the initial incorrect payment, or overpayment, vary. Sometimes the initial payment was made to the dentist and other times it ... [continue reading]
Ohio Dental Association membership surveys have consistently reported that ODA members rank the "monitoring [of] the dental insurance industry and advocating dental insurance benefits" as a high priority objective for the association. The dentists who volunteer their time at the American Dental Association, ODA and local dental societies and the ... [continue reading]
Last month's column focused on the dental insurance resources that are available to Ohio Dental Association member dentists via the ODA. In this month’s issue, we'll take a look at the many resources that the American Dental Association has to help members with third party payment issues.
Third party payer advocacy and individual ... [continue reading]
The views expressed in the articles and columns on oda.org are solely those of the author(s) and do not necessarily represent the view of the Ohio Dental Association (ODA). The columns are intended to offer opinions, information and general guidance and should not be construed as legal advice or as an endorsement by the ODA. Further, information posted on oda.org is not an endorsement by the ODA and should be viewed on an informational basis by users of the website. Dentists should always seek the advice of their own legal counsel regarding specific circumstances.
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