In recent years, the VDA has heard from numerous members regarding a myriad of issues they were facing with insurance companies and this led to the formation of a the VDA Insurance Work Group consisting of Drs. Mike Morgan, Roger Palmer, Marcel Lambrechts and Ted Corcoran, Chuck Duvall and Tripp Perrin.  For over a year now, this group has been working hard to help address insurance issues that are important to VDA members.

The group first requested that VDA members submit issues with supporting documentation to VDA staff.  Many issues were submitted and the group reviewed and analyzed the complaints.  Certain issues were selected as possibly being addressed by the VDA and there were many issues that were deemed to be outside the purview of the VDA.  The group has discussed how to address the several issues and there were two issues that were decided to be the highest priorities: 

Silent PPOs and United Concordia’s (UCCI) position regarding radiographic evidence of bone loss in order to approve benefits for scaling and root planing.  

What is the Silent PPO issue?

Dentist’s contracts with dental benefit companies are being rented to other networks with whom the dentist never signed a contract.  The process is known as “Network Rental” or “Silent PPO.”  These rentals can take place without the dentist’s knowledge or consent.  Additionally, some dentists have found that their fee schedules in the new networks differ from their original agreed upon contract.

The ADA offered a webinar on June 26th titled The Growing Impact of PPO Leasing on Your Practice and it can be found archived on their website.  We encourage members to view this webinar.

How does the VDA plan to address the Silent PPO issue?

The Council on Government Affairs supports pursuing new legislation to be presented to the 2019 VA General Assembly to address problems associated with Silent PPOs.  With the approval of the VDA Board of Directors and then the VDA House of Delegates, this legislation would be introduced in 2019 and VDA members will be called upon to help in these efforts. 

How has the VDA attempted to address the issue with UCCI?

The CA Dental Association had asked the ADA to enter into discussions with UCCI for a variety of issues, including the scaling and root planing denials.  At the request of the ADA, the VDA submitted a letter to UCCI stating the VDA’s opinion of their company’s position regarding the scaling and root planing issue.  The intention of the discussion and our letter is to persuade UCCI to change their position on this without getting involved in legislation or legal action.  At the time this article was submitted, no written change in policy had been received from UCCI.  The VDA will continue update members on this issue.

Other Insurance Issues

A number of our members have complained to us that they have been audited electronically by insurance companies and received letters that our members felt were thinly veiled accusations of fraud because their billings were “outside the norms of their peers.”  Also, some dentists are not listed on insurance companies’ websites because they don’t accept the lowest paying fee schedule.

We have had several conversations with the companies and voiced our concerns. While all of the issues were not resolved to our complete satisfaction, we have made some progress and we have open communications.

Dentist’s Administering Flu Vaccine

At our January Committee Meeting, Dr. Zag Zapatero presented a compelling presentation regarding dentists providing flu vaccinations in their offices. We formed a work group consisting of: Drs. Dag Zapatero, Ray Lee, Rick Taliaferro and Patrice Wunsch.

It seems that, even with pharmacies and others proving flu vaccinations, not enough people are being vaccinated to stem the spread of flu epidemics. Because we see basically healthy people and often more frequently than physicians do, the dental office could be an excellent place to provide this service.

We have a number of questions that need to be answered including insurance coverage. We would also have to introduce legislation to the Virginia General Assembly in order for us to provide this service.

Our work on the initiative is ongoing and we will have a proposal to the VDA House of Delegates at the Omni Homestead Resort in September.