Answers to your questions
What’s the process for going out of network with a plan?
The first step to going out of network with a dental plan is to evaluate the potential impact on the practice. Secondly, you will want to develop a system for notifying the plan and patients that you’ll be an out-of-network provider.
CDA members can sign in to access a helpful resource on What You Need to Know About Dropping Dental Plan Contracts.
Do you have updated fee schedules for my area?
Due to anti-trust laws, CDA does not provide or collect any fee schedule information. Call or email a CDA analyst who can suggest a few sources where you can purchase a fee schedule based on your location.
What can I charge for non-covered services?
How do I address claim denials?
First, determine if the denial is due to dental plan payment policy guidelines by reviewing the plan’s provider manual or clinical criteria. If the denial is not due to policy, review the EOB Explanation of Benefits (EOB) for steps on how to file a formal appeal with the plan. The plan has to acknowledge and make a determination on a formal appeal within 45 days.
Members can sign in to access a comprehensive Dental Benefit Plan Handbook, including guidance on Understanding the Claim Appeal Process.
Do I have to comply with a plan’s request to submit records for review?
Resources for members
Sign in to access all member resources for navigating appeals, audits, billing, carrier-specific needs, claims, contracts and coordination of benefits.
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Dental benefit plans in the news
For this California dentist, dropping dental plans was necessary for practice’s long-term sustainability
Dr. Jennifer Chiang discusses her path from associate dentist to practice owner in California and why she chose exit all dental plan contracts to sustain her practice.
Audit will evaluate state’s contract with Delta Dental of California
California's 600,000 employees and retirees are having trouble using their Delta Dental benefit, and an audit supported by CDA and approved by the Legislature seeks to understand why.
Blindsided: Practice owner details the pitfalls of dental plan leased networks
Dr. Zeynep Barakat details how unknowingly contracting with leased networks led to incorrect fees, delayed care and patient frustrations.
