Reminder: Free Virtual CE on August 16 – Increase the Efficiency of Insurance Administration

Course Description

It is no secret that insurance companies have invested a lot of time and effort in employing questionable claims processing guidelines in an effort to reduce what they pay out to dental practices. The insurance industry has mastered a number of concepts found in the book "The Art of War" to help them master deceptive business tactics against dental offices. This course will bring light to these Art of War concepts in a way that will allow participants to better defend themselves from the apparent and perceived "abuse" they receive from insurance companies. At the end of this course participants will have a better understanding on how to apply Art of War Concepts to counteract abusive, illegal, or otherwise unethical acts on the part of insurance companies. An example of this is how do you really get an insurance company to stay out of clinical care? Do insurance companies have a right to deny a case of scaling and root planing because they (the insurance plan) doesn't agree with your diagnosis? Are insurance companies allowed to alter or change Current Dental Terminology? How do I reduce the rate of denials on covered treatment that patients need? This course will provide key answers to these questions and more.

Subtopic A: Policing Illegal and Unethical Acts by Insurance Companies

One of the reasons why insurance companies push the envelope on engaging in unethical, or otherwise illegal activity, is because most of their acts go unchallenged by dental offices. Yes, you may send a stern letter or an aggressive appeal to the insurance companies but those appeals often fall on blind eyes and deaf ears. As a result, your concerns never get addressed and these insurance related problems never go away. Many in the dental industry know that State Insurance Commissioners are there to advocate on behalf of patients for insurance coverage issues but most dental practices get turned away when seeking the assistance of a government entity like the Insurance Commissioner.

Subtopic B: Non-Covered Services and the Federal HITECH Act of 2009

Most states have passed laws that prohibit insurance companies from enforcing low PPO fees for non-covered services. However, since nearly half of all dental plans are issued by an employer that "self-funds" their dental benefits, most state laws become obsolete as Self-Funded plans are governed by ERISA at the federal level. Federal laws indicate that ERISA eligible dental plans are exempt from state laws and state licensing requirements. As such, many dental practices are not able to charge their full or otherwise fair fees for non-covered services.

Learning Objectives

• Learn how to effectively engage government entities in a partnership to advocate on behalf of patients who are not gaining access to insurance benefits they need paid for and benefits they need.
• Have a better understanding of which government entities can be involved in the claims appeal process and what steps should be taken to get those governing entries involved in fighting for your patients’ rights.
• Learn what the options are in being able to bill patients fair and reasonable fees for non-covered services by fully utilizing provisions of the federal HITECH Act of 2009.
• Learn how to place safeguards in billing protocols to protect the financial integrity of quality care.