Insurance Connection
By John Basial , Esq and Vince Pinizzotto , CHC
2020 has been a very unusual year for dentists and dentistry . COVID-19 has made every part of your practice more difficult . There were new regulations , new procedures , new mandatory equipment and new ways of seeing patients – at one point changing almost on a daily basis .
When the virus began to spread throughout the world Pennsylvania chose the very unusual path of banning all dental procedures except for those performed in a negative pressure treatment room . As your practice was being threatened , PDA adapted and got to work immediately . Thanks to our advocacy , the Pennsylvania Department of Health ’ s ( DOH ) guidance was modified to a more realistic way of practicing . Once this happened , dentists could see patients on an emergency basis . Things slowly returned to a more traditional style of practice , but with restrictions that didn ’ t exist as the year 2020 began .
We had a change in leadership on the Dental Benefits Committee ( DBC ). Dr . Tad Glossner resigned as DBC chair to help with another committee and Dr . David Spokane is the new chair . Thank you Dr . Glossner for your leadership and leaving the committee in a very good place . Welcome aboard Dr . Spokane ! We all look forward to working with you .
Prior to COVID-19 arriving in our state some DBC members met with United Concordia and achieved a number of favorable policy changes . Attempts to meet with Delta Dental were less successful as their executive staff had all been recalled to California and all policy decisions come out of that state .
Because the pandemic has caused significant changes in your practice the DBC has adapted to better serve you . We have requested virtual meetings with the insurance companies , the Pennsylvania Department of Insurance ( DOI ) and the Pennsylvania Attorney General ’ s ( AG ) Office to address ongoing issues and to proactively broach topics for future discussion . The committee has , as of late , been focused on resolving COVID-19 related issues , such as personal protective equipment ( PPE ) reimbursement , and has sent correspondence to the insurers requesting that they implement programs and raise reimbursement levels to assist dentists .
For a prolonged period of time , dental offices were prohibited from scheduling recall patients . This prohibition produced a timing predicament in most dental offices since the subsequent recall visit would bump up against the six-month limitation . Consequently , DBC contacted some of the major insurance carriers to ascertain their position relative to the six-month limitation clauses that are contained in virtually all insurance contracts . United Concordia responded and indicated that they are waiving the six-month limitation for all dates of service through December 31 , 2020 . Delta opted to maintain current benefit configurations .
The DBC plans to pursue the following topics in 2021 :
• Continue building relationships and meet regularly with representatives from the major dental insurers . The committee would like to make better inroads with individual insurance companies in order to achieve changes to standard contract language that are more equitable to dentists .
• Use all of PDA ’ s electronic and written communication tools to better educate members on third-party payer issues and resources available to them , including the ADA ’ s Contract Analysis Service .
In order to be as helpful to you as possible we continue to be as proactive as we can be . Please keep us posted on the emerging issues that are important to you .
If you have questions or need assistance please contact John Basial jpb @ padental . org or Vince Pinizzotto vjp @ padental . org at ( 800 ) 223-0016 .
PDA Webinars Available
Virtual gatherings and informative webinars have become a big part of things since March .
PDA has provided numerous virtual programs , with most of them recorded . You can find all of these recorded webinars , including the Leadership e-Series “ Bridging the Info Gap ” programs , on our PDA Go mobile app . On the app , go to Resources and find the Webinars folder where you will find a single interactive document . You can also find webinars on PDA ’ s website , on the Membership menu , where you can scroll down to Webinars and find the page with all available recordings .
NOVEMBER / DECEMBER 2020 | PENNSYLVANIA DENTAL JOURNAL 13