Category: Dental Insurance & Medicaid

The Ohio Dental Association often receives questions from member dentists regarding whether they are able to receive reimbursement for services when the patient does not complete the prescribed course of treatment, e.g., a tooth has been prepped but for whatever reason the crown does not get seated. Patient non-compliance, benefit plan changes and ... [continue reading]

The Ohio Dental Association's Dental Insurance Working Group and ODA member dentists throughout the state have identified an apparent trend when it comes to dentists' interactions with dental insurance companies and third-party payers. Many payers don't seem willing to simply take the dentist's word on some dental insurance claims that certain ... [continue reading]

To have a dental claim denied that the dentist believes is appropriate and necessary treatment is bad. To have a claim in the same situation disallowed or deemed not billable to the patient is horrible. Claim denials typically result from limitations or exclusions contained in the patient’s dental benefits plan, e.g., the patient has ... [continue reading]

It appears the Ohio Dental Association has played an instrumental role in overturning a decision to terminate the participating provider status of a number of ODA member dentists with one of Ohio's Medicaid HMOs. Earlier this year numerous ODA member dentists received correspondence from DentaQuest stating that their offices would no longer be ... [continue reading]

Ohio Dental Association members continue to address situations where an insurance company or other third-party payer wants 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]

Ohio Dental Association membership surveys have consistently reported that ODA members rank the "monitoring [of] the dental insurance industry and advocating dental insurance benefits" as a high priority objective for the association. The dentists who volunteer their time at the American Dental Association, ODA and local dental societies and the ... [continue reading]

Last month's column focused on the dental insurance resources that are available to Ohio Dental Association member dentists via the ODA. In this month’s issue, we'll take a look at the many resources that the American Dental Association has to help members with third party payment issues. Third party payer advocacy and individual ... [continue reading]

ODA Director of Dental Services Chris Moore gives a CE seminar about dental insurance issues at the 2019 ODA Leadership Institute. To schedule a free seminar, a dental society or dental school can contact the ODA to reserve one at (800) 282-1526. The most recent Ohio Dental Association membership survey, like all of the previous ... [continue reading]

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]