In fact , the ADA is doing a lot about dental insurance at the organizational , federal , state and industry level to reform the insurance sector . Following is an outline of some of the many ADA dental insurance initiatives .
1 . Lawsuit against Delta Dental : The ADA and two individual dentists filed class-action lawsuit against the Delta Dental Plans Association , its affiliated national entities and 39 independent Delta Dental companies , alleging the provider network has engaged in anticompetitive conduct and violated federal antitrust laws . This lawsuit remains ongoing and serves as the strongest action against a major dental insurance carrier .
2 . Federal Advocacy : The ADA successfully lobbied Congress for the repeal of the McCarran-Ferguson Act ’ s exemption from certain provisions of the antitrust laws of healthcare insurance . The ADA believes that the exemptions provided in this 1945 law have resulted in a general absence of scrutiny of health insurance companies by the federal government . In fact , before the exemption was eliminated Delta Dental asserted it as a defense to the ADA ’ s class action lawsuit . ADA is hopeful that the FTC and DOJ will now more actively investigate suspected anticompetitive conduct and pursue sanctions when it is found — creating a fairer dental insurance marketplace .
3 . State Advocacy : At the state level , the ADA is supporting several state dental associations with robust advocacy resources and grant funding to reform dental insurance . For example , this support helped 41 states pass laws limiting insurers ’ ability to dictate dentists ’ charges for non-covered services . Almost half of the states require insurers to notify dentists about leased networks , and some now must allow dentists to opt out of the lease . Over 80 different dental insurance reform proposals are active just in 2021 , including PDA ’ s continuing efforts to enact Assignment of Benefit ( AoB ) legislation .
4 . Industry solutions : a . Bento : Bento , endorsed by the ADA , is a start-up technology company that fully replaces a dental benefit administrator for self-insured employers .
This means there is no middle man secondguessing the dentist ’ s treatment plan . Using Bento ’ s award-winning and easy-to-use app , patients approve their treatment plans ( and not consultants ) on their phones while still in the chair ! Dentists get paid directly – with everything being automated and electronic . The Bento platform even allows dentists to offer in-office plans . Learn more about Bento at ADA . org / Bento . Bento supports real-time eligibility & benefits verification , real-time claims adjudication , fast and easy direct payment to dental offices , along with cost transparency for patients , ultimately leading to a better dentist-patient relationship .
b . Credentialing : Every single insurance carrier requires dentists participating in their network to re-credential , usually every three years . On average it appears dentists participate with at least 15 carriers . This translates to completing the same paperwork 15 times every 3 years . Over 70,000 dentists now use the ADA credentialing service , powered by CAQH ProView , to digitally store and submit their credentialing paperwork across different carriers — allowing dentists and their staff to focus on patients and the practice . Learn more about the credentialing solution at ADA . org / credentialing .
5 . Education : Sometimes it may help to simply understand the landscape better to succeed ! To help train office staff to file claims efficiently , the ADA offers courses through the ADA ’ s Coding Academy . Additionally , there are new free webinars offered each month and ready to use resources and Frequently Asked Questions at ADA . org / dentalinsurance , all aimed at providing solutions to complex dental insurance questions to our members .
The next time someone asks you “ what is the ADA doing about dental insurance ? ” you can answer “ a lot !”
Please support ADPAC and PADPAC , and take advantage of the industry and educational programs that the ADA endorses and sponsors . The ADA has got your back !
( The information in this article has been adapted from materials prepared by Krishna Aravamudhan and Roxanne Yaghoubi of the American Dental Association .)
JULY / AUGUST 2021 | PENNSYLVANIA DENTAL JOURNAL 27