Insurance For Dentists

Navigating benefits can be confusing and frustrating for dental practices, so the American Dental Association is sharing information and resources related to three new trends impacting dentists.

Some payers are raising the frequency limitation on fillings from two to five years.

“Frequency limits within the dental insurance landscape are something that dentistry has learned to navigate. Now, the landscape appears to be changing,” said Rod Hill, D.D.S., a former member of the ADA Council on Dental Benefit Programs. “While we as dentists have learned to accept the standard ‘warranty’ periods of 24 months for fillings and 60 months for crowns, we now must deal with the longer periods imposed by the insurance companies to decrease their liability.”

Some plans pass the fee on to patients, giving them the impression the restorations should last for the amount of time the insurance company deems appropriate, Dr. Hill said.

Patients often refer to the payment plan for their dental care as “insurance.” However, it’s technically a different type of health care plan known as a benefit plan, which covers only certain costs. The ADA has created a brochure titled “Why Doesn’t My Insurance Pay For This?” that explains this and other related matters to help patients better understand their dental benefit plans.

A second emerging trend relates to changes in how out-of-network claims are paid. Aetna has changed the way it determines these fees, leading to decreased reimbursements for dentists who are not in network.

As of Jan. 1, Aetna’s fees are based on the average amount insurers pay for services in a dentist’s geographic area as opposed to the average amount providers charge, as reported by Fair Health. Fair Health is a nonprofit with a database of more than 46 billion health care claim records that it uses to estimate average billing and allowed amounts across the country.

A third trend relates to network leasing. MetLife and Guardian will be leasing their networks to each other effective June 1. Both MetLife and Guardian providers can opt out of the leasing arrangement by following instructions provided to them in communications from the companies.

Courtesy of the American Dental Association.