Category: Dental Insurance & Medicaid

The Ohio Dental Association continues to see problems for many dentists when it comes to obtaining third-party payer reimbursement for core buildups. Sometimes these problems have resulted in the third-party payer requesting additional information from the dentist, denying the claims for the service or disallowing the claim in question. (Generally ... [continue reading]

The Ohio Dental Association has expressed its concerns to Aetna concerning a letter it sent to at least one ODA member dentist regarding Aetna's new payment practices. According to the letter, Aetna stated it had “changed our payment policy to only send electronic payments.” The letter also said the dentist “must enroll in an ... [continue reading]

The Ohio Dental Association receives a number of calls from member dentists concerning ways to either attract new patients to their practice or keep existing patients within the fold. A common theme among these callers involves the dentist’s willingness to discount his or her fees in some manner to “compete” with major preferred ... [continue reading]

In recent months, the Ohio Dental Association has received an increased number of calls from ODA member dentists regarding the proper way to report the names of the treating dentist and billing entity to third-party payers. Most of the calls were prompted by a dental practice bringing on an associate for the first time and some involved dentists ... [continue reading]

Dealing with the subject of fees can be a sensitive issue, but at the same time it is a necessary part of the patient-dentist relationship. The subject can become exponentially more difficult when a third-party payer becomes involved in the discussion. One of the most antagonizing things a dentist can encounter involves an assertion that his/her ... [continue reading]

A recently adopted law in Connecticut has prompted a number of questions from Ohio Dental Association member dentists concerning similar situations in Ohio. The Connecticut statute, which went into effect on Oct. 1, allows dentists in that state to refuse insurers’ virtual credit card claims payment methodology (i.e., “single-use ... [continue reading]

What do the Ohio Dental Association; Delta Dental of Michigan, Ohio, and Indiana; and the peer review process all have in common? They all are concerned about issues related to medical necessity and quality of dental care. How they address these issues and particularly disputes involving them, however, varies significantly. Peer Review Peer ... [continue reading]

The Ohio Dental Association routinely receives calls from member dentists concerning efforts by third-party payers 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]

Dentists who sign participating provider agreements with preferred provider organizations (PPOs) and other contracting organizations acknowledge they must know and comply with terms of those agreements. A case recently submitted to the Ohio Dental Association's Dental Insurance Working (DIWG) illustrates the need for dentists to be aware of the ... [continue reading]

Every month, a dedicated group of Ohio Dental Association member dentists volunteer their time to serve during conference call meetings of the ODA Dental Insurance Working Group (DIWG).  These dentists determine the ODA’s role in addressing dental insurance related questions, concerns and complaints involving third-party payers that are ... [continue reading]