INSURANCE CONNECTION
We ’ ve been asked ……
Is there a Pennsylvania law which mandates that an insurer identify on their EOBs that they ’ ve subcontracted with a third party ?
Our researchers could find no Pennsylvania law , per se , that specifies that a dental insurer must state this information on an EOB . However , we reviewed participation agreements of major insurance companies and noted that most contain a stipulation that indicates signing a participation agreement would include participation with any current or future ( our emphasis added ) affiliate .
PDA members should also be aware that some insurance companies subcontract with other insurance companies for the purpose of sharing fee schedules . There has been a trend in recent years where insurance companies contract with other third-party payers . Usually , the most common example is where one insurance company borrows ( or leases ) the fee schedule from another company .
One example of this leasing arrangement is Aetna and Assurant / Dental Health Alliance ( DHA ). If you have signed a participating provider contract with Aetna , you may find out that Assurant and Dental Health Alliance patients will also come to your office under their fee schedule even though you have not signed a contract with Assurant or DHA . This could be a good thing or a bad thing depending on your practice and your needs . If you are in need of patients , the extra stream provided by the company leasing the fee schedule could benefit you . However , if you normally see Assurant / DHA patients on an out-of-network basis , this could dramatically affect not only your revenue but the way your office handles administrative issues with Assurant / DHA . Each situation has to be assessed individually . It ’ s important to remember that the contract you signed with a particular insurance company takes precedence over any other third-party arrangement .
Here are some other recent examples of leasing arrangements between insurance companies :
■ Principal lease with Ameritas
■ Aetna leases with Assurant / DHA
■ Assurant / DHA leases with United Concordia
■ Dentemax leases with Blue Cross
■ Connection Dental leases with Principal , Aetna , Assurant , Cigna , Guardian ( and others )
As with all contracts , it is important to review participation agreements before signing with an insurer . If a PDA member would like an analysis of a participation agreement prior to signing it , please forward an electronic copy of the agreement to Vince Pinizzotto , Insurance Carrier Consultant , at vjp @ padental . org . PDA will forward the agreement to the ADA for analysis and notify the member once the analysis is complete .
— Dr . Anand V . Rao , First District Trustee
Comprehensive Compassionate Care
Exclusively Dedicated to Patients with Special Needs
Special Smiles , Ltd SAVE THE DATE
2nd Annual MOM-n-PA
At Special Smiles , we focus solely on serving the needs of patients with intellectual and physical disabilities who require general anesthesia for dental care .
Call 215-707-0575 For an appointment or consultation
www . specialsmilesltd . com
The second MOM-n-PA dental mission will be held in Allentown on Friday , September 12 and Saturday , September 13 , at the Agri-Plex at the Allentown Fairgrounds . Last year the MOM-n-PA mission provided more than $ 850,000 in free dental services with more than 1,000 volunteers taking part in the event . You can help with the 2014 effort by volunteering your services or making a donation . For more information , visit the website at www . mom-n-pa . com .
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