HAVE A PROBLEM WITH A DENTAL INSURANCE SITUATION? THE ODA MAY BE ABLE TO HELP!

HAVE A PROBLEM WITH A DENTAL INSURANCE SITUATION? THE ODA MAY BE ABLE TO HELP!

If you have been unsuccessful in resolving a dental insurance or third-party payer situation, you may want to consider submitting information to the Ohio Dental Association’s Dental Insurance Working Group (DIWG) to determine if the ODA has a role in addressing the matter.

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.

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 working group has assisted many ODA members 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.

There are several ways for members to submit an issue to the DIWG: