- Lawsuit against Delta Dental: The ADA and two individual dentists filed a class-action lawsuit against the Delta Dental Plans Association, its affiliated national entities and 39 independent Delta Dental companies, alleging the provider network has engaged in anticompetitive conduct and violated federal antitrust laws. This lawsuit remains ongoing and serves as the strongest action against a major dental insurance carrier.
2. Federal Advocacy: The ADA successfully lobbied Congress for the repeal of the McCarran-Ferguson Act’s exemption from certain provisions of the antitrust laws of healthcare insurance. The ADA believes that the exemptions provided in this 1945 law have resulted in a general absence of scrutiny of health insurance companies by the federal government. In fact, before the exemption was eliminated Delta Dental asserted it as a defense to the ADA’s class action lawsuit. ADA is hopeful that the FTC and DOJ will now more actively investigate suspected anticompetitive conduct and pursue sanctions when it is found—creating a fairer dental insurance marketplace.
3. State Advocacy: At the state level, the ADA is supporting several state dental associations with robust advocacy resources and grant funding to reform dental insurance. For example, this support helped forty-one states pass laws limiting insurers’ ability to dictate dentists’ charges for non-covered services. Almost half of the states require insurers to notify dentists about leased networks, and some now must allow dentists to opt out of the lease. Over 80 different dental insurance reform proposals are active just in 2021! Learn about current activity across states at Dental Insurance State Reform Legislation 2021.
4. Industry solutions:
a. Bento: Bento, endorsed by the ADA, is a start-up technology company that fully replaces a dental benefit administrator for self-insured employers. This means there is no middle-man second guessing the dentist’s treatment plan. Using Bento’s award-winning and easy-to-use app, patients approve their treatment plans (and not consultants) on their phones while still in the chair! Dentists get paid directly – with everything being automated and electronic. The Bento platform even allows dentists to offer in-office plans. Learn more about Bento at ADA.org/Bento. Bento supports real-time eligibility & benefits verification, real-time claims adjudication, fast and easy direct payment to dental offices, along with cost transparency for patients, ultimately leading to a better dentist-patient relationship.
b. Credentialing: Every single insurance carrier requires dentists participating in their network to re-credential, usually every three years. On average it appears dentists participate with at least 15 carriers. This translates to completing the same paperwork 15 times every 3 years. Over 70,000 dentists now use the ADA credentialing service, powered by CAQH ProView, to digitally store and submit their credentialing paperwork across different carriers—allowing dentists and their staff to focus on patients and the practice. Learn more about the credentialing solution at ADA.org/credentialing.
5. Education: Sometimes it may help to simply understand the landscape better to succeed! To help train office staff to file claims efficiently, the ADA offers courses through the ADA’s Coding Academy. Additionally, there are new free webinars offered each month and ready to use resources and Frequently Asked Questions at ADA.org/dentalinsurance, all aimed at providing solutions to complex dental insurance questions to our members.