by Drs. Jason Flannagan and Megan Keck, Council on Dental Benefit Programs
2017 was an active year in the dental insurance world and we saw a lot of changes.
Shared Network Agreements
Connection Dental and Cigna ended their shared network agreement. The Cigna networks can no longer be accessed with a contract with Connection.
United Healthcare and Guardian forged a new shared network agreement in December 2017. If your office is contracted with either of these companies, you will now have access to the other network unless you choose to opt out of this partnership.
United Concordia added Lincoln and Ameritas to their shared network agreement. These networks are now accessed with a UCCI contract.
Maverest was bought out by Zelis. Maverest fee schedules that were already in place were allowed to remain but Maverest no longer exists as its own entity.
TRICARE Dental Plan
The Department of Defense awarded United Concordia a five-year contract to administer the TRICARE dental program. Previously, MetLife had been administering dental benefits for military members covered under TRICARE. If you wish to be considered an in-network provider for the TRICARE plan, United Concordia will allow a stand-alone TDP contract without having to be a preferred provider for their other networks.
More and more insurance companies are utilizing third parties to handle their re- credentialing. This has caused some issues for offices. We encouraged you to follow up with these insurance companies to ensure they have received your re- credentialing information. If you do not return re-credentialing by the due date you will be bumped out of network and, if that happens, you may not get your previous fee schedule reinstated.
Delta Dental continues to employ policies that make it very difficult not to participate in its network. If you are an out-of-network provider, Delta Dental will not honor the assignment of benefit request on the claim submission. Therefore checks will be sent directly to the patient and not the out-of-network provider. Delta Dental also implemented a new fee schedule with lower reimbursement rates for new PPO enrollees. This lower reimbursement can have a dramatic effect on practice transitions.
BC/BS of Michigan
Blue Cross Blue Shield of Michigan is sending checks that, when deposited, obligate the provider to accept the check as “payment in full” for services provided. By endorsing the check, the provider is accepting the in-network fee schedule for that claim and can not balance bill the patient for anything other than deductibles and copayments.
If the provider does not want to participate in this manner, then the assignment of benefit box should not be checked when submitting the claim. BCBS will then send the check to the patient and the provider can bill the full fee.
The IDA and ADA strongly condemn the carriers’ practice of disallowing (instead of denying) claims. This practice by some carriers prohibits in-network providers from billing the patient anything for disallowed claims.
Council on Dental Benefit Programs
The IDA Council on Dental Benefit Programs serves as the Association’s information source for all matters pertaining to dental benefit programs, public and private. The Council represents the Association to all local, state and federal agencies and administrators in all matters concerning dental benefit programs and also coordinates with the Council on Governmental Affairs regarding any legal or legislative issues pertaining to dental benefit programs.
For more information on the Council, its duties, and its members, visit the Council on Dental Benefit Programs web page.