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Every quarter, CDA publishes a Practice Health Check focusing on a different topic related to the business side of dentistry. Dental plan benefits are the focus in the fourth quarter of 2023. CDA members are invited to take the Q4 Practice Health Check evaluating one key question.

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. 

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.

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.

CDA Practice Support occasionally hears a complaint from dental offices that a plan granted a preauthorization for treatment and then denied payment when the claim was submitted. Digging a little deeper into these complaints, there may be some confusion between what constitutes a “preauthorization” and what is a “predetermination” or pre-estimate of benefits.