Insurance Companies
Delta sneaking change for restorative codes
I think I saw somewhere post about insurance changing anterior two surface fillings to one surface claiming that we can get mesial decay without lingual or facial approach.
I got my first claim for 2016 where delta dental for retired military officially started downgrading all anterior fillings to single surface composites. They sneaked in the 2016 coding changes on their website adding:
" Additionally, the following processing policy updates are effective January 1, 2016:
D2330-D2335 – resin-based composite restoration(s) – one to four or more surfaces, anterior. Multi-surface resin-based composite restorations on anterior teeth will be modified to single surface restorations when they do not include the incisal angle or both proximal surfaces." Posted: 2/3/2016 9:05:55 AM
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I have never understood insurance changing codes. We are to report WHAT WE DID. They can change that to whatever they want to pay for. But you better be exactly correct when reporting to them exactly what you did.
If we change a code or report a code inaccurately - its fraud. Why are the rules different on the other end?
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What a load of garbage, talk about encouraging insurance fraud.
Delta sneaking change for restorative codes
I just started having problems with Delta on this exact issue.
I just don't get how they can downgrade a 2-surface to a 1-surface merely because it doesn't include the incisal edge or the other proximal surface. Do I now have to start breaking the incisal contact so I can bill a 3 surface
Delta sneaking change for restorative codes
This is insane. You know what comes after this, right? No more 2 or 3-surface posterior restorations. All your MOs and DOs will just be converted to Ds and Ms.
I really think these guys sit in a room and think up the next way they can rip off, degrade, and humiliate us dentists just because they can. They know we won't do anything about it.
Delta sneaking change for restorative codes
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So now when buying a practice you'll have to adjust the production for all one surface fillings, wonderful .
No way this sticks, what is the point of "keeping" delta patients if you're getting paid less than half of your fee?
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Delta sneaking change for restorative codes
Why in the hell are we putting up with this?? Delta needs dentists more than we need Delta. How long can the profession afford to see these patients at a potential loss?
Delta sneaking change for restorative codes
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Quote: (jeremygordon)
Why in the hell are we putting up with this?? Delta needs dentists more than we need Delta. How long can the profession afford to see these patients at a potential loss?
Wish this were true, but simply is not. Delta would love for all Dentists to be employed by large corp. entities that they can negotiate with, DHMO style. Until then, they are being very generous allowing the current fees as is.
And as long as new graduates/chains/startups/group practices/corps keep lowering the bar, we haven't seen a floor yet.
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Delta sneaking change for restorative codes
I thought if you broke the marginal ridge, it is a 2 surface fill. Don't take it personally guys, it is just the inscos racheting down stuff. At some point, they will decide one prophy a year is enough.
....some days you are the forcep, some days you are the tooth.
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Delta sneaking change for restorative codes
Quote: (lholwager)
Oh, I just can't stand this!!!!! It's bad enough that we get paid for a 3 surface fill when a tooth has a ML AND separate DL fill. What's next??????!!!!!!!!!!!!!!
Look, you can't participate in insurance and then say "they aren't playing fair". This is a huge business and no, they don't play fair. They are ruthless and only concerned with their bottom line. That is why each and every claim is called a loss. They are no more concerned with the dental health of their subscribers anymore then they are concerned with their subscribers' love lives.
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ADA Council On Dental Benefit Programs Asks Delta Dental To Reject Proposed Disallow Policy.
The ADA News (5/9, Soderlund) reports, “The ADA Council on Dental Benefit Programs wants Delta Dental to reject a proposed policy that would automatically disallow claims where more than two quadrants of scaling and root planing were performed on the same date of service.” On April 27 council chair Dr. Ron Riggins sent a statement on behalf of the council to Dr. Bill Kohn, vice president of dental science and policy, making the request. “We feel this new policy not only intercedes into dental care treatment planning but may also harm patients by creating unwarranted challenges to their scheduling for needed treatment,” Dr. Riggins wrote. “Interference with the doctor-patient relationship is ever increasing and is of significant concern to the ADA.
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on 10/24/2015 7:57:24 AM SandiHudson posted this new Topic
A reminder to offices that participate with multiple PPOs to watch carefully about shared network agreements. Sometimes shared network agreements work to your advantage so that you can get higher fees through a third party than you could get with a direct contract. But they can also work against you if the insurance company shifts you down to a lower paying option through a shared network agreement.
A few recent ones to be especially cautious about:
United Concordia - if you participate with UCCI you need to really stop an look at this one. There are two relatively recent shared network agreements that can now pay on the UCCI fee schedule and since UCCI is almost always the lowest paying fee schedule in a practice you can find other companies now paying on it. The more notable ones are DenteMax, Florida Combined Life (the path for BC of FL) and DNOA (the path for BC in IL, OK, NM, TX, MI, AL). If you participate with both UCCI and one of these other contracts they can now pay you on the lower paying UCCI contracted rates. In some states you may find this to not have much impact but in other states it can be very significant. In Texas, for example, let's say that you have a DenteMax contract that was picking up BC of TX and you have $100,000 a year in production with BC and the UCCI rates are 20% lower you could find yourself with a $20,000 loss in collections and have no idea it's happening. Note that you can keep UCCI in place but opt out of their shared network agreements but you must opt out or you will be automatically opted in.
Aetna and Guardian - if you took only Aetna in the past, they can now pick up Guardian and vice versa. If you are contracted with both, your direct contracts still apply.
Ameritas and Principal - they have a shared network agreement in place where if you take Ameritas only they will pick up Principal and if you have Principal only, they will pick up Ameritas. In the past, if you have had a direct contract with both companies the direct contract will take priority (Ameritas applies to Ameritas, Principal to Principal). This is now changing and if you have contracts with both and Principal is lower, you may find Ameritas paying on the lower Principal rates.
If you participate with multiple third party administrators (Connection Dental, DenteMax, Careington, Maverest, etc.) step back and look to see if you really need several in place. If you can eliminate the lower paying ones and only keep 1 third party admin, the highest paying one of course, you are better off starting to flush out the lower paying ones. Start strategically positioning yourself so that as more of these go into effect you can't get other companies pushed downward.