Category: Dental Insurance & Medicaid

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]

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). They address the wide variety of dental insurance related questions, concerns and complaints that are submitted by ODA member dentists seeking help on matters they ... [continue reading]

In early April the Ohio Department of Medicaid (ODM) announced which insurance companies it has preliminarily selected to administer the $20 billion managed care or Medicaid HMO portion of Ohio’s Medicaid program. They are AmeriHealth Caritas Ohio, Inc.; Anthem Blue Cross and Blue Shield; CareSource Ohio, Inc.; Humana Health Plan of Ohio, ... [continue reading]

Within the last two years, DentaQuest has garnered a lot of attention from Ohio dentists as it began administering the dental component of CareSource’s Medicaid HMO product and through its acquisition of the private insurance company Dental Care Plus Group (DCPG). Representatives of the Ohio Dental Association, through the ODA Medicaid ... [continue reading]

When it comes to managed care contracting issues, one of the more common calls the Ohio Dental Association receives involve leased dental networks. Callers’ questions typically are something like: How can I be bound to a plan’s fee limits when I never signed a contract with that plan? Can I stay in the network but opt out of one or two ... [continue reading]

The Ohio Dental Association Council on Dental Care Programs and Dental Practice continues to monitor and address third-party payer issues on the ODA membership’s behalf. One issue of particular note that the council has been monitoring involves silent discount arrangements that are commonly known as “silent PPOs,” “ghost PPOs” or ... [continue reading]

Effective May 1, 2020, CareSource transitioned the administration of the dental component of its Medicaid HMO product to DentaQuest. A number of issues have emerged as a result of this transition. Representatives of DentaQuest and the Ohio Dental Association, through the ODA Medicaid Working Group, have been working together to identify and then ... [continue reading]

Like with almost everything else, 2020 was a challenging year for dentists and dental offices when it came to dental insurance and third-party payment issues. While nothing seemed to come easy, the volunteer member dentists who served on the ODA Dental Insurance Working Group and the ODA as a whole took an active role in assisting the membership ... [continue reading]

The Ohio Dental Association has written Aetna Dental PPO to express its concerns with a recent decision by Aetna to substantially reduce network dentists’ reimbursement. The ODA’s action is in response to a number of ODA member dentists who contacted the ODA after receiving a letter from Aetna Dental PPO that it would be utilizing a new fee ... [continue reading]

The end of this year will mark the end of the 133rd General Assembly. That means all pieces of legislation pending before the Ohio legislature that have not been adopted into law will be discarded. If these legislative proposals are eventually to become law they must then be re-introduced and begin the legislative process all over again in the ... [continue reading]