Read real-life dentist scenarios and how the ADA helped. If you have an issue with dental benefits – contact the ADA today.
- A dental office was having difficulty terminating its network participation with a PPO leasing company and was getting nowhere. The ADA was successful in helping the office submit the necessary paperwork to the proper department and thus was able to help the office terminate its network participation.
- The ADA helped a member dentist get a claim for crowns paid after a couple of unsuccessful attempts on the part of the dentist. The plan originally approved the pre-determination but subsequently denied the actual claim. After the ADA contacted the plan, a decision was reversed and the claims were paid.
- The ADA worked with a Medicare Advantage plan to help a dentist receive claim payments because the plan thought the dentist had opted out of Medicare when in fact the dentist had enrolled in Medicare using form 855i. It was the intervention from the ADA that helped the dentist get paid.
- A dental office was having problems receiving payment from a plan for claims from two years ago and after much intervention the ADA was able to help the dental office receive payment.
- A dentist was ordered to repay $400,000 subsequent to a RAC audit, based largely on a coding issue. The ADA, using its expertise and authority as the preeminent CDT expert, succeeded in getting the agency to reconsider and change its interpretation of the Medicaid Department. The dentist settled for $700.
- A dental office was having a problem with a new satellite office being credentialed for benefit plan participation that had been dragging on for months. Through persistent ADA intervention, the problem was solved.
- A member dentist in Arkansas had two SRP claims denied due to lack of bone loss which was not true. The ADA contacted the plan and asked that the plan take another look at the radiographs. After another review, the plan agreed to pay the claims.
- A member dentist in Indiana had a claim denied by a plan because of incorrect information it had on file; however, the plan blamed a PPO leasing company for the incorrect information. After multiple communications with both companies, the ADA was finally able to get the issue resolved and the claim paid.
- The ADA convinced a plan to eliminate language in communications the plan used which made it look like the ADA was to blame for a denial. After the ADA expressed its concerns to the plan, the plan agreed and changed the inflammatory language.
- A member dental office had problems with a plan incorrectly paying another dental office and this had been going on for months. The ADA contacted the plan and the issue was subsequently resolved.
- A dental plan used language on an EOB statement indicating that procedure D1354 was investigational. The ADA contacted the plan expressing our concerns over the fact that it was not investigational and the plan agreed to change the EOB language accordingly.
These are examples of successful interventions on behalf of the ADA. Please note the ADA does not have authority over dental carriers and may not be able to get your individual concern resolved.