Billing, Contracts and Fees

In a victory for California dentists and their patients, Gov. Newsom has signed CDA-sponsored legislation that will help dental offices communicate the details of dental plan coverage to their patients. Plans also will be required to disclose whether a patient’s plan is state or federally regulated.

CDA’s experts answer members’ questions about adding a new dentist or utilizing locum tenens and the accompanying considerations for the dentist’s working relationship with dental benefit plans. 

Reports from CDA members during the last week on contract change notification letters sent by Delta Dental of California raise additional concerns for CDA about the proposed changes. 

Do you have a question about a dental benefit issue? You can receive timely assistance from a CDA Practice Support expert. Simply submit your question online using the dental submission form available within your cda.org account. 

Cindy Hartwell, dental benefits analyst at CDA Practice Support, reviews how a dental practice can bill properly by registering all treating dentists in the practice with the dental plan or plans.

CDA Practice Support is receiving calls from dentists and their staff concerning claim denials for scaling and root planing services by dental benefit plans. In this article, I review the criteria utilized by dental plans when reviewing claims for scaling and root planing and why some of the plan denials are correct based on the American Dental Association’s definition of scaling and root planing. 

Patients with some form of dental coverage or benefit to offset their out-of-pocket cost are more likely to accept a treatment plan. Offering an in-house discount plan can assist with attracting new patients and help retain existing patients, particularly those patients without any form of dental coverage.

Adding or dropping a contract with a dental benefit plan is a personal business decision. There is no “one size fits all” in these types of business decisions, as what might work for one dentist might not work for another. You may be asking yourself how a dentist can make a good decision about adding or dropping a dental plan/network participation, but there is one key element in each success story.

Congratulations — the dental plan paid the claim! Or did they? Confirmation that your claim has been processed comes in two forms: payment and/or an explanation of benefits. An EOB is sent to the patient and/or dental office as a receipt of services provided. Unfortunately, dental plans do not have standardized formats for these documents, which is why it’s necessary for an office to read the EOB completely.