Help with dental insurance is just a click, email or phone call away, part 1
The most recent Ohio Dental Association membership survey, like all of the previous surveys, reported that the membership ranks the ODA’s “monitoring [of] the dental insurance industry and advocating dental insurance benefits” as a high priority objective for the association.
Many dental practices learn what they know about dealing with dental insurance and third-party payment issues through a process of trial and error. While this may be helpful in the learning process, it can also be stressful and not always beneficial to office efficiency.
There are many resources both at the Ohio Dental Association and the American Dental Association that member dentists can utilize that are typically just a phone call, email or computer keyboard click away. This month’s issue of the Dental Insurance Corner will focus on the resources available to member dentists via the ODA and next month’s column will detail those of the ADA.
The ODA provides information
Every month the “ODA Today” is delivered to all ODA member dentists. Each issue includes a column, the Dental Insurance Corner, that addresses dental insurance issues being faced by Ohio dentists.
“I encourage ODA member dentists to consider passing on the ‘ODA Today’ or at least the dental insurance column to their staff who handle insurance issues to provide them with an additional resource to better do their jobs,” said Dr. Manny Chopra, chairman of Council on Dental Care Programs and Dental Practice. “Dentists are also encouraged to submit their ideas or suggestions for topics or questions that can be addressed in future issues.”
The ODA website, www.oda.org, is also readily available to member dentists. It hosts past issues of the Dental Insurance Corner along with Medicare and Medicaid related resources.
ODA representatives present dental insurance seminars at ODA, local dental society and dental school functions throughout the year. Three presentations have given so far in 2019 to the Northeastern Ohio Dental Society, at The Ohio State University College of Dentistry and at the ODA Leadership Institute, and two more are currently scheduled to be presented by the end of the year. To schedule a free seminar, a dental society or dental school just needs to contact the ODA to reserve one.
Past ODA Annual Sessions have featured seminars addressing dental insurance and other forms of third-party payment issues. This year’s Annual Session will include two information packed seminars on insurance billing by the highly regarded speaker, Christine Taxin. On Friday, Oct. 4 Taxin will present “Cutting-Edge Dental Billing and Coding: Maximizing Patient Care and Profitability” from 2 to 5 p.m., and on Saturday, Oct. 5 she’ll present “Billing Medical in Your Dental Practice: Maximize Practice Revenue with New Services and Procedures” from 9 a.m. to noon. Additional information about these seminars as well as the entire Annual Session may be obtained at https://www.oda.org/news-and-events/annual-session/.
The ODA provides individual member assistance
ODA staff can be reached at (800) 282-1526 or (614) 486-2700, via fax at (614) 486-0381 or via email at firstname.lastname@example.org to answer questions, provide direction, resources and assistance. With 70 years of combined experience, the ODA staff have the dental insurance expertise, institutional knowledge, legal expertise and oftentimes personal contacts to assist members and/or their offices successfully address confounding dental insurance problems, issues and questions.
If an issue is beyond the ODA staff’s ability to address or requires a more formal response, then member dentists can utilize the services of the ODA Dental Insurance Working Group (DIWG). The DIWG is comprised of a dedicated group of ODA member dentists who volunteer their time each month to determine the ODA’s formal role in addressing dental insurance related questions, concerns and complaints involving third-party payers that are submitted by ODA member dentists. The working group has been around for many years and has proven itself to be an effective advocate and counselor to ODA members who have encountered problems with third-party payers.
Current DIWG members include: Dr. Jacqueline Cerar (Mentor); Dr. Manny Chopra (Cincinnati); Dr. Joseph M. DePalma (Dillonvale); Dr. Mary Ann Hanlon (Cincinnati); Dr. Purnima Kumar (Columbus); Dr. Gregory C. Michaels (Lancaster); Dr. Richard R. Ragozine (Girard); Dr. Jason M. Streem (Cleveland); and Dr. David L. Vorherr (Cincinnati).
Past working group actions have ranged from answering questions from confused dental practices to addressing procedure code revisions to contacting third-party payers on behalf of individual dentists to filing complaints with regulatory agencies to developing recommendations for future ODA legislative initiatives.
ODA members who would like to utilize the working group’s services should submit their question, concern or request for assistance along with supporting documentation (e.g., description of the situation, copy of the submitted claim form, claim denial with explanation of benefits, copy of any appeal, photographs, radiographs or any other information that would assist the working group understand the situation) to the ODA Dental Insurance Working Group, 1370 Dublin Rd., Columbus, Ohio 43215 or via fax at (614) 486-0381 or via email to email@example.com. They should also be sure to redact information that would identify specific patients unless the patient has granted the dentist permission to disclose his or her identifying information to the ODA.
“The working group has assisted many dentists over the years to address problems they were unable to resolve on their own,” Chopra said. “It has also worked to facilitate the two-way flow of communication between the dental profession and Ohio-based dental insurance companies. While some insurance companies are noteworthy in their refusal to work with us in a meaningful way, many are very responsive in addressing issues of concern ranging from clarifying their decisions to revising their practices. I encourage ODA members to take advantage of this service when they have dental insurance questions or are unable to resolve matters on their own with a particular carrier.”
ODA-Delta Dental claims review project
An outgrowth of the DIWG’s efforts has led to the ODA and Delta Dental of Michigan, Ohio, and Indiana to work on a joint project to develop an additional resource to assist member dentists who encounter certain claim disallowances by Delta (i.e., the claim is denied and the dentist is barred from billing the patient for any part of the fee associated with the denial). Once developed, the program will enable members whose claims are disallowed for reasons associated with medical necessity and quality of care to appeal Delta’s final determination to the ODA for a final adjudication.
“As we currently envision it, the ODA will utilize an appropriately trained mix of general dentists and/or specialists to review certain claims after ODA members have exhausted Delta’s internal review process to make a final decision on the disposition of the claim,” Chopra said. “We are hopeful and optimistic that Delta and the ODA will be able to develop a workable process that will both provide more transparency to the dental insurance process while at the same time be a significant member benefit. We are very appreciative of Delta’s willingness to work with us on this new program.”
Contract Analysis Service
“ODA members are strongly encouraged, in fact, urged to utilize the Contract Analysis Service before they sign into any participating provider agreements,” Chopra said. “Obtaining an objective analysis is an integral part of a dentist’s decision making process before he or she signs on the bottom line.”
The Contract Analysis Service is a no cost service that assists member dentists in understanding terms and obligations of contractual agreements with third-party payers. It takes contract legalese and translates it into easy to understand language and also identifies potentially problematic contract provisions and their possible impact on the dental practice. This information can help the dentist either negotiate more favorable contract terms or at least have a fuller understanding of what to expect as a result of entering into the agreement.
To utilize the Contract Analysis Service, ODA members simply need to contact the ODA Department of Dental Services at (800) 282-1526 and request an analysis for whichever contract they are considering. If the contract has already been analyzed, then its analysis will be sent to the member at no charge. If the contract has not been previously submitted to the ODA for review, then the dentist will be asked to send the ODA an unsigned copy of the contract. The ODA will then forward it to the American Dental Association where the ADA’s attorneys will analyze it. The ADA will return the completed analysis to the ODA, which will then provide it to the member dentist, again at no charge.
The ODA educates lawmakers on dental insurance issues
The ODA lobbying team is continuing its efforts to gain legislative relief for dentists when it comes to the issue of non-covered services. Non-covered services involve arrangements whereby the insurance company contractually dictates the fee a dentist may charge for dental services that are not even covered by the carrier. This fundamentally unfair practice unnecessarily interferes with the patient-dentist relationship. It has been, and continues to be, a priority legislative issue for the ODA and will be a focus of the advocacy efforts of the volunteer dentists who participate in the ODA Day at the Statehouse.
In-office dental plans or membership plans
In-office dental plans or membership plans work off the principle that for a fee, a patient gets a membership in a plan that affords him or her access to various free and/or discounted dental services in the dental practice that is selling the plan. The ODA Services Corp. (ODASC) is currently evaluating these types of programs with an eye toward possibly endorsing one.
Have a question or concern about dental insurance?
If you have a question about a dental insurance issue or need help resolving a dispute, contact the ODA – we’ve got you covered! Our staff can answer questions or direct you to resources available to you through your membership.
Phone: (800) 282-1526
Fax: (614) 486-0381