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Dental insurance participation wasn’t fun to manage before COVID. Now there’s even more to consider.

Dental insurance expert Colleen Huff,  FAADOM, shares what dentists and insurance coordinators should be reviewing during this insightful conversation with Patent Prism CEO Amol Nirgudkar. Huff has 20 years of experience as one of the country’s top dental practice management consultants, plus she continues to run the offices of two dentists in Buffalo, NY. She knows firsthand how the changes in dental benefits impact business operations.

 

 

Which Dental Insurance Carriers Reimburse for PPE?

There’s a wide variety of dental insurance carriers that are starting to pay for PPE, for at least the short-term. In most cases, you need to be in-network with the carrier and some carriers require ADA codes and a narrative, while others are more lenient.

Huff worked with another consultant to create a Google document to track it. Click here to view the spreadsheet or you can access it through www.Facebook.com/DentalInsuranceCoach.

It’s being updated daily.

The ADA also has Coding and Billing Interim Guidance materials available.

 

Dental Practice Insurance Audits

It’s important to note that some contracts specifically state you can’t charge for infection control.

“If that’s in your contract and you charge your patient anyway, then you’ve breached your contract,” explains Huff.

Huff said it’s a mistake to think dentists won’t get caught for violating their contracts. She said more carriers will be performing audits for a number of reasons.

Says Huff, “I know for a fact from some of the reps that I’ve talked to that insurance companies are going to be auditing more dentists who saw patients during the shut-down to make sure the work they did fell within the guidelines.”

 

Is Now a Good Time to Evaluate Dental Insurance Participation?

Dentists are looking at their contracts to evaluate whether the fees they collect from the carriers are worth staying in-network.

Huff said to begin by analyzing your data.

“You have to know your bottom number," Huff said. "What is the lowest amount you’re willing to accept? You have to know that data ahead of time. Don’t go into a negotiation without knowing what you’re trying to make your end result.”

Huff said there are several considerations, including:

  • Have you analyzed your data?
  • Which patients will be affected if you go out-of-network?
  • Can you renegotiate your rates?
  • Is there competition for patients with the same plan in your area?
  • Is the carrier going to start offering an EPO plan to patients this year?

 

EPO stands for Exclusive Provider Organization. It doesn’t cover any care a patient receives out-of-network. For a dental practice, this means they won’t be able to bill the carrier.

This could have an impact on fee-for-service dentists who typically will help their patients maximize their benefits by filing on their behalf as an out-of-network provider. That won’t be an option for patients with an EPO plan.

To find out if EPO plans are being offered in your area, ask your provider reps.

 

Double-Check Patients’ Insurance Eligibility

One of out five people lost their jobs between March and June. That could impact their insurance benefits eligibility.

Unfortunately, that could be harder to check than it used to be. Many companies also furloughed their HR teams, so the companies may not be sending up-to-date employee information to the insurance providers. That could lead to back-dating when they do finally return to work.

Many insurance carriers also laid off workers, so they have fewer people available on their side to manage the changes in coverage.

A good place to start is to ask your patients if there’s been any changes in their dental insurance coverage.

“You definitely can’t assume that whatever was there in February is still there now,” Huff said.

 

How to Use Dental Insurance to Attract Patients

Most people are confused by all the insurance plans, limitations, deductibles, and coinsurance information.

For her own dental practices, Huff created a letter that helped patients know what questions to ask as they evaluate their dental insurance options.

“Seniors don’t know what they’re looking at, so this helps them to understand what’s being offered. Do they just need preventative? Is it worth it to them to spend extra money every month to have a plan that covers more?”

Pre-COVID, Huff recommended dental practice insurance coordinators talk to their reps about health fairs and other events that the reps would attend.

“It’s a great way to have your doctor be able to speak to a group for a half-hour and get your name out there,” Huff explained.

Now, dental insurance reps may need to get more creative. Definitely ask them how they’re reaching potential patients, Huff suggested.

 

Additional Resources

Colleen Huff’s website

Colleen Huff’s Facebook page

Colleen Huff’s PPE Reimbursement Spreadsheet

ADA COVID-19 Resources

For more interviews with experts, training resources, and guides, visit Academy.PatientPrism.com.

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