Dental Benefit Plans

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. 

Every July, CDA Practice Support starts hearing from members who have received notice from a dental benefit plan about a forthcoming audit. CDA's dental benefits analyst explains the post-pay audit, when dentists must participate in the audit and dentists' right to appeal the findings.

CDA Practice Support continues to hear from member dentists impacted by Delta Dental of California’s contractual change under Participating Dentist Rule 2, Basis of Fees that took effect September 15, 2018. Dental practices can take action annually to avoid negative impacts.

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.

Delta Dental of California’s proposed reductions to the “maximum allowable fees” for approximately 2,200 endodontists, periodontists and oral surgeons in California will not take effect July 1, as previously scheduled. Instead, Delta Dental has decided to indefinitely postpone the previously announced fee reductions. 

CDA has heard from many specialist members — endodontists, periodontists and oral surgeons — who are facing reimbursement reductions under their Premier provider contracts with Delta Dental of California

CDA Practice Support answers a member's question about whether a noncontracted dental benefits plan has a legal right to the contracted fee discount of another plan that the dentist does have a contract with. 

Delta Dental of California has announced a delay in implementing fee structure changes for endodontists, periodontists and oral surgeons. Due to uncertainty caused by COVID-19, Delta said it plans to delay the implementation date of Jan. 1, 2021, to July 1, 2021.

California Insurance Commissioner Ricardo Lara last Wednesday issued a notice to California health insurance and specialized health insurance companies, including 55 dental benefits companies, requesting that they “provide their policyholders with a partial premium refund no later than December 31, 2020.

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.

With baby boomers exiting the workforce and losing their employer-sponsored dental coverage, consumers are enrolling in Medicare, the federally administered health care program for all seniors age 65 and older. Practice Support has seen an uptick in member calls related to Medicare Advantage dental plans due, in part, to the aging patient population in their practices and increased Medicare enrollment.