Dental benefit basics

ADA resources address insurance ins and outs

Understanding the ins and outs of dental benefit plans can be complicated and frustrating for many dental offices and especially overwhelming for dentists early in their careers. Luckily, the American Dental Association is here to help with guidance for navigating these challenges.

Below are some ADA resources and tools new dentists may find helpful. They are available at ADA.org/dentalinsurance.

• Introduction to Dental Benefits: This guide from the ADA provides dentists with all the basics they need to know to get started in the complex and confusing world of dental benefits by outlining differences in plan type, funding, design, management, benefits and limitations.

• Dental insurance guides: The ADA offers a multitude of other guides related to dental insurance. They cover topics such as noncovered and nonbillable services, coordination of benefits, claim submissions for crowns and core buildups, eligibility verification and more.

• ADA Third Party Payer Concierge: ADA members with dental benefit questions or concerns can call the ADA Third Party Payer Concierge for free, personalized help. The concierge is available from 8:30 a.m.-5 p.m. CT Monday through Friday at 1-800-621-8099 and dentalbenefits@ada.org.

• Contract analysis service: When dentists receive a dental insurance contract, they should evaluate it thoroughly to determine if signing the contract is a sound business decision. The ADA offers a free contract analysis service to help members assess terms for a variety of contract types. To use the service, dentists should submit a copy of the unsigned contract and an analysis request through their state dental society.

• Contract support webpage: In addition to the contract analysis service, the ADA provides other contract-related resources, including a contract negotiation guide and a guide to terminating a network agreement, on a webpage dedicated to insurance contract issues. It is accessible from the main dental insurance page.

• How to File an Appeal: If a claim is denied, this guide can help dentists file strong appeals. It addresses the appeals process, offering written appeal templates, documentation checklists and tips to navigate multiple levels of appeal.