New dentists may have many concerns when it comes to their patients’ dental plans, benefits and thirdparty payers, often because little of their dental school education relates to learning how to navigate these issues.
Among the concerns are preauthorization requirements, delays in processing claims, claim denials, refund requests and the lack of assignment of benefits to nonparticipating dentists.
Staff of the Center for Dental Benefits, Coding and Quality within the ADA Practice Institute continually receive and address a variety of dental claim submission and adjudication questions from member dentists and practice staff. While many times there are unique concerns, there are often similar questions — which the staff is happy to answer.
The staff has come up with a list of the top five concerns of dentists when it comes to dental benefits, based on calls received from dental offices.
What follows is a brief description of the top five concerns, followed by a resource that member dentists can turn to for further help in those areas. Many more resources are located at ADA.org/dentalbenefits, part of the ADA Center for Professional Success.
The top five concerns, in no particular order, are:
• Provider contract issues.
• Claim rejection. “I know that many dental offices do not take the time
to appeal denied claims, and that’s unfortunate,” said Dr. Steve Snyder, chair of the Council on Dental Benefit Programs. “My recommendation is that if you have a claim that you think should be paid, take the time to teach your staff on how to file a proper appeal.”
• The related trio of bundling, downcoding and the least expensive alternative treatment clause.
• Coordination of benefits. “Increasingly, the ADA receives calls from dentists who want to know which plan is primary and want to know why the secondary carrier refused to pay or paid very little,” said Dr. Snyder. “Calls on coordination of benefits are some of the most frequent calls staff at the ADA receive on dental benefits issues.”
• Electronic fund transfers. The switch to electronic reimbursement by some third-party payers has prompted the ADA Practice Institute to study how dentists could make the change in their offices. “The ADA recognizes that electronic funds is on the road to becoming the preferred payment method of the future,” said Dr. Mark Mihalo, chair of the council’s Coding and Transactions Subcommittee.
Staff from the Center for Dental Benefits, Coding and Quality can help new as well as more experienced dentists with their dental benefit-related problems, questions and concerns. The ADA Third-Party Payer Concierge, a service of the center, can be reached at 1-800-621-8099 or at dentalbenefits@ada.org.
Everyone complains about non-Hippocratic for-profit Third Party Insurers interfering with Hippocratic Patient-Doctor Relationship (PDR) without a third party clinical examination which makes it illegal oral health care. Doctors have to hire 20-30% more staff to submit complex claim forms if we “Crack the Code with Fixed Fees” for Third Party profit, and “Maximize unprofitable Benefits” for only 50% of patient premium payers. Meanwhile, thousands of third party employees and executives are bonused hundreds of millions of dollars to deliberately delay, reject, bundle, downcode, coordinate “out” of “dual” benefits, approve least expensive alternative treatment that cannot be applied to Hippocratic PDR choices, and charge for electronic fund transfer payments. Does any other business in the world charge you to get paid? Third Party’s created the most expensive health care system in the world resulting in worse outcomes than third world countries.
Shouldn’t Third Party Insurer’s be held responsible to fulfill their promise of health care to premium payers and only charge a 7-10% administrative fee? In fact, doctors should eliminate third party profiteers completely and the ADA should should establish a legal replacement Doctor’s Dental Plan that only charges a 7-10% administrative fee. Of course, in a free enterprise society, each doctor may decide their own UCR fees and provide expected SET TLC oral healthcare like they are licensed to do in each state. Let the state licensing boards decide if the doctor is providing Selfless, Excellent, Trustworthy oral healthcare built on Truthful, Likeable, Compassionate actions that protect the public, not Third Party profiteers who have no interest in protecting the public, nor providing Hippocratic oral healthcare.
Medicaid for the poor and needy with 40% UCR fees for limited procedures, and Medicare for seniors with no coverage are worse. Doctors would be happy to provide oral health care for 100% IRS tax deduction up to annual taxes owed and again allow the state licensing boards to do their job. If the doctor is not Hippocratic by the state licensing board, the IRS has many legal ways to punish violations who make illegal tax returns. Dental Schools would also be interested to help their educational institutions and universities use their reduced taxes to support dental clinics for their students, faculty, needy, poor, and seniors.
We need to come together, save our Hippocratic profession, and serve the public, not third party profits. Together Opportunity’s Magic. Vote T.O.M. Mahalo!
Yes I completely agree-
We are in the healthcare because we believe in serving those in need , however between third party and insurance companies -it becomes more difficult to practice and earn an honest living .
You are absolutely correct. Third parties including insurance companies interfere with healthcare. Eliminate third parties and quit playing their game where they can change the rules at any time fix fees, and reduce reimbursements. Try the ADA Direct Reimbursement Dental Plan focused on Hippocratic Patient-Doctor Relationship where you build trust and the patient chooses their oral health.
Amen to that !