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.

It is important that dentists and their teams know and understand their rights when appealing a claim denial and how the law can protect you and your patient. To minimize the frustration of dealing with a claim denial, it is important to understand how a lot of claims are processed today.

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.

The American Dental Association publishes updates to the Current Dental Terminology (CDT) code set on an annual basis. The codes contain descriptive terms developed and updated by the ADA for reporting dental services and procedures to dental benefit 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.

CDA was notified by Delta Dental of California that it will reduce fees for periodontists, endodontists and oral surgeons in its Premier provider network. Delta Dental sent letters to Premier providers to explain changes to its fee structure, which will affect approximately 2,200 specialists statewide. Originally, the fee reduction was to take place July 1, 2020, but on April 4 Delta Dental announced it will postpone the effective date to Jan. 1, 2021.

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.

CDA-sponsored legislation that further increases dental plan transparency became law on Jan. 1. AB 954 requires dental plans to be more transparent about the leasing of dental networks. The new law will reduce patient and dentist confusion caused by the increasing number of plans leasing their networks to other payers, many times unbeknownst to the enrollee or contracted dentist(s). The law took effect for contracts entered into on or after Jan. 1, 2020.