Category: Dental Insurance & Medicaid

Reimbursement rates paid by preferred provider organizations (PPOs), Medicaid, managed care plans, dental health maintenance organizations (DHMOs) and other similar third-party payers are typically the primary consideration for general dentists in deciding whether to join or remain in a dental network. They can also be a major factor for ... [continue reading]

Volunteer dentists are continuing to assist Ohio Dental Association member dentists and their offices in addressing dental insurance and other third-party payer matters. They predominately serve on the ODA’s Executive Committee, Council on Dental Care Programs and Dental Practice (CDCPDP), Dental Insurance Working Group (DIWG) and Medicaid ... [continue reading]

Dealing with the subject of fees can be a sensitive issue but at the same time a necessary part of the patient-dentist relationship. The subject can become exponentially more difficult when an insurance company or other third-party payer becomes involved in the discussion. One of the most antagonizing things a dentist can encounter involves an ... [continue reading]

The state’s proposed budget for fiscal years 2024 and 2025 was introduced on Feb. 15, 2023, in the form of House Bill 33. In preparation of the budget, the ODA has been advocating with policymakers and state leaders for a significant increase in dental Medicaid reimbursements for the last year. Throughout the last half of February and the entire ... [continue reading]

The Ohio Dental Association often receives questions from member dentists regarding whether they are able to receive reimbursement for services when one of their patients 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 ... [continue reading]

If you have been unsuccessful in resolving a 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 ... [continue reading]

By the end of June, the Ohio General Assembly will pass, and Governor Mike DeWine will sign into law, a budget for the state of Ohio covering state fiscal years 2024 and 2025. In anticipation, the ODA has been educating policymakers for the last year about the need for substantial increases in funding for Ohio’s dental Medicaid program. My ... [continue reading]

Medicare and Medicare Advantage Plans The number of people covered by Medicare Advantage Plans has increased significantly in recent years. In fact, enrollment in publicly funded dental benefit plans, namely Medicaid and Medicare Advantage Plans, represent the segments of the dental benefits marketplace that have seen significant growth in ... [continue reading]

Multiple procedure reduction pricing on fee-for-service dental claims The Ohio Department of Medicaid (ODM) is responding favorably to a claims processing policy change that had begun to negatively impact Ohio dentists in a very significant way after being contacted by the Ohio Dental Association. The situation involves claims for multiple ... [continue reading]

Receiving a clear, concise explanation of the terms of a provider contract may help you decide if participating with such a plan is best for you and your patients, as well as helping you avoid unpleasant surprises under the contract in the future. The ADA Contract Analysis Service will provide you with information concerning a proposed contract ... [continue reading]