Dental Insurance Assistance

We understand the challenges that come with navigating third-party payers and insurance relationships. As a benefit of your membership, the ODA provides opportunities to help get the support you need.

ODA Staff Assistance

Contact Us Directly

Our ODA staff is available to answer questions about dental insurance and third-party payer information as a benefit of your membership. To utilize this service, call the ODA at (800) 282-1526 or email dentist@oda.org.

EMAIL US

ODA DENTAL INSURANCE WORKING GROUP (DIWG)

How to Submit an Issue to DIWG

If you have been unsuccessful in resolving a third-party payer situation on your own, consider submitting your issue to the DIWG via our confidential and secure online form below.

  • Include all supporting documentation that will help the working group understand the situation. Documentation should include everything that was submitted to the insurance company and the response(s), such as  a description of the situation, copy of the submitted claim form and claim denial with the explanation of benefits, copy of any appeal, photographs, radiographs, charting, etc. .
  • Remember to redact all information that would identify any specific patients.

If you prefer to submit your insurance issue via mail, fax or email, please send all documentation to: ODA Dental Insurance Working Group 1370 Dublin Rd., Columbus, Ohio 43215 or via fax at (614) 486-0381 or via email to chrism@oda.org

SUBMIT YOUR INSURANCE ISSUE

The DIWG is comprised of a dedicated group of ODA member dentists who volunteer their time to determine the ODA’s formal role in addressing dental insurance-related questions, concerns and complaints involving dental insurance and third-party payers that are submitted by ODA member dentists.

This working group meets the second Tuesday of every month via conference call to address dental insurance questions, concerns, complaints, etc. that are submitted by ODA member dentists

DIWG members also serve on the Council on Dental Care Programs and Dental Practice, and their services are only available to ODA member dentists.

Learn more about the Dental Insurance Working Group.

If you have been unsuccessful in resolving a third-party payer situation, you may want to consider submitting information to the Dental Insurance Working Group to determine if the ODA has a role in addressing the matter.

The working group has served for many years as an advocate and counselor to ODA members who have encountered problems with third-party payers.

  • The DIWG will review the information you have provided to ensure they have a deep understanding of the issue.
  • ODA staff or a working-group member may reach out to you to get additional information or answers to questions.
  • The group then determines the ODA’s role in best assisting you, including contacting the dental insurance company on your behalf when appropriate.
  • When appropriate, the DIWG will provide you with documentation of the ODA’s efforts you can use to add credibility to your position with the patient involved.
Sometimes, having the strength of the larger ODA organization behind you helps provide some form of relief for your concerns.

The working group has assisted many dentists over the years to address problems they were unable to resolve on their own; and has worked to facilitate the two-way flow of communication between the dental profession and Ohio-based dental insurance companies. The working group has addressed such issues as:
  • Denials or limitations for certain services (such as core buildups, crowns, endodontic therapy, scaling and root planning and radiographs).
  • Payment of non-contracting dentists.
  • Applications of participating provider agreements.
  • Application of least expensive alternative benefit clauses.
  • Participating provider listings.
  • Focused review, utilization review and other types of audits.
  • Dentist rating systems.
  • Overpayment recovery.
  • CDT dental code usage.
  • Unfair cuts to fee schedules.
While some insurance companies choose not to work with DIWG in a meaningful way, many are very responsive in addressing issues of concern ranging from clarifying their decisions to revising their practices.

Dental Insurance Corner

The “Dental Insurance Corner” is published monthly in the “ODA Today” to answer frequent questions and help members with common third-party payer issues. The ADA also features numerous resources including webinars, publications, guides, and more.

Dental Insurance News & Resources

Oct192021
The Ohio Dental Association has written Cigna Dental to express its concerns with a recent decision by Cigna to substantially reduce network dentists’ reimbursement. The ODA’s action is in response to a number of ODA member dentists who contacted the ODA after receiving a letter from Cigna Dental that it would begin utilizing a new fee ... [continue reading]
Sep92021
While there is a clear trend for dentists to join into participating provider agreements with managed care plans now more than ever, the Ohio Dental Association has received a marked increase in the number of member dentists inquiring about how to terminate their contracts with networks they participate in. Some of the callers were just starting ... [continue reading]
Aug112021
Over the years the number of calls to the Ohio Dental Association concerning prompt pay issues have dropped dramatically. Dentists’ adoption of electronic claims submission technology and insurance companies’ utilization of automatic claims processing practices have significantly helped with the timely adjudication of many claims. Slow ... [continue reading]

Questions?

Contact our ODA staff today at (800) 282-1526 or the email below to learn more about how we can help resolve your third-party payer issues. Dental Insurance Assistance is an exclusive ODA member benefit.