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S3 E08: Mastering Dental Fee Negotiations
Frustrated about contracts and fees? Expert tips to help you become a negotiating pro!
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Feeling frustrated about contracts and fees? Don’t know how to break up with your provider? We’re bringing in experts with tips to help you become a negotiating pro!
Special Guests: Dr. Christopher Bulnes and Dr. Sara Stuefen
“Each time I've kind of made a decision like this, it's been emotional. But you have to put it all together. It can't just be the emotion, right? We've got to look at the health of our practice.”
- Dr. Sara Stuefen
“Identify the codes that you use most often and really hone in on those, and always ask for an increase.”
- Dr. Chris Bulnes
- In this episode of Dental Sound Bites, dental insurance issues are often listed among the most important issues confronting dentists. Whether it’s contract concerns, fee frustration, or breaking up with a provider, you don't have to navigate these difficult situations on your own. We’re bringing in experts with tips to help you become a negotiating pro.
- Our guests for this episode are Dr. Chris Bulnes, and Dr. Sara Stuefen, who both serve on the ADA’s Council on Dental Benefit Programs.
- Dr. Sara Stuefen practices general dentistry in Vinton, Iowa. She devotes much of her free time to organized dentistry. Dr. Stuefen is a member of the ADA Council on Dental Benefit Programs, trustee for the Iowa Dental Association, and trustee-elect for the American Dental Association.
- Dr. Bulnes is a general dentist in Tampa, FL. He earned his Doctor of Dental Medicine degree from Southern Illinois University School of Dental Medicine, Alton, IL. He is also past Chair and a past member of the ADA Council on Dental Benefit Programs.
- Dr. Bulnes and Dr. Stuefen explain the work the council does, and how it impacts dentists everywhere.
- What exactly can dentists negotiate on their contracts? Our guests answer the questions that they get asked most frequently, and give insight into provider manuals.
- What is the ADA doing to get dentists higher reimbursements? ADA’s resident dental insurance expert, Dennis McHugh, answers that question. Plus, he lists the resources available to help you with contract negotiations, and a tip that may help you get a fee increase.
- Dr. Steufen and Dr. Bulnes explain the process of breaking up with your network or provider, and why you must always also consider the health of your practice.
- What is the Employee Retirement Income Security Act (ERISA) and how can dentists find out which laws are in their state? The panel explains ERISA, and why there is so much confusion about how it impacts state laws.
- A look at what’s next in the dental insurance landscape, and with dental insurance reform.
- Check out all the information you need to help solve your dental insurance issues.
- Find support on dental insurance contract issues.
- Increase your chances of successful claims submissions.
- Looking for help with contract negotiations? This toolkit could help (PDF).
- Learn more about ERISA here, and visit ADA.org/DIR.
- Get the toolkit on Terminating a Dental Agreement.
- The ADA’s Third Party Payer Concierge is available to answer your questions. Call 800.621.8099, or email firstname.lastname@example.org.
- Listen to another Dental Sound Bites episode about solving your dental insurance dilemmas.
- The conversation continues after the show. To listen to exclusive bonus content, download the ADA Member App today
Ioannidou: [00:00:00] Dental insurance issues are often rated among the most important issues confronting dentists. Contract concerns, fee frustration, breaking up with the provider. You don't have to navigate these difficult situations on your own. I'm Dr. Effie Ioannidou.
Wright: [00:00:17] And I'm Dr. ArNelle Wright. And in this episode, we are bringing the experts with tips and tools to help you become a negotiating pro.
Announcer: [00:00:27] From the American Dental Association, this is Dental Sound Bites. Created for dentists, by dentists. Ready? Let's dive right into real talk on dentistry's daily wins and sticky situations.
Ioannidou: [00:00:43] So, ArNelle, grab a pen.
Wright: [00:00:46] I got it.
Ioannidou: [00:00:47] Get your notebook.
Wright: [00:00:48] Yes.
Ioannidou: [00:00:49] We need to take notes today. Our ADA dental insurance experts are back to help us navigate these issues, the contracts, the fees, and all these gazillion questions that dentists might have.
Wright: [00:01:01] Yeah, I'm super excited about this episode. And I'm sure all of our listening community, they are ready to hear what our experts have to say.
So hi, everybody. We have Dr. Chris Bulnes and we have Dr. Sara Steufen. Can you please tell our listening community who you are, where you practice, and how you know so much about dental insurance?
Stuefen: [00:01:21] Yes. I am Sara Stuefen. I am a general dentist in Benton, Iowa, and I serve on the ADA's Council on Dental Benefits and Program.
So with that, that means a lot of exposure to what's going on, what dentists are experiencing as their issues with dental insurance. And over time, you build up expertise with that.
Ioannidou: [00:01:41] Sara, can I ask a question here? I'm curious. Do you serve in the ADA Council for Benefits because of your interest or did you develop your interest while serving?
Wright: [00:01:53] Oh, that's a good question.
Stuefen: [00:01:55] That is a good question.
Wright: [00:01:56] Hot seat, hot seat.
Stuefen: [00:01:59] I definitely had an interest beforehand, but my interest grew that much more once I got involved because then you start, you start learning even more. And then for me, at least, it became a passion and I just want to know even more.
Thank you. Yeah.
Wright: And we appreciate you for serving on these councils, both you and Chris, I'll let you give your introduction, but we appreciate all the knowledge that you guys are going to bring to this conversation today. Dr. Bolnus.
Bulnes: [00:02:24] Yeah. So my name is Dr. Chris Bulnes. I'm a general dentist in Tampa, Florida.
I actually met Dr. Steufen on the Council on Dental Benefits and Programs. I was one of her Chairs. So I think how Dr. Steufen got so interested, and so involved, is that she came to us as a one-year term new dentist, and usually they would rotate those folks throughout the councils. However, because she was so great and read her agendas and spoke up at the meetings and was very knowledgeable, we asked for her back again and again and again. So I think maybe Sara, you've been on seven years?
Stuefen: [00:02:57] Oh, not quite. Five, five or six.
Bulnes: [00:03:01] Yeah, she's up there. So she was a star.
Wright: [00:03:04] Well, tell us what the Council on Dental Benefit and Programs is. I know it has this fancy acronym. Tell all of our listeners what the acronym is and what it entails.
Bulnes: [00:03:15] CDBP, so Council on Dental Benefits and Programs. So there's kind of two arms of it, right? So one, we deal with the code. The code that we use each and every day. That's how we send that out to our benefit companies. We like to use the word benefit company, not insurance companies.
Wright: Key point, everybody.
Bulnes: And how we seek reimbursement. The other side is our dental benefits insurance, DBiz, which is a subcommittee. That's where we deal with the payers, right? That's where we're talking one to one with all the major payers, all the major – I would say consortiums – that represent payers like National Association of Dental Plans, American Health Insurance Plans. We have a seat at the table with them to talk about our gripes, talk about what they're doing, talk about what we're doing.
Sara, what do you think? What's changed in the council?
Stuefen: [00:04:00] So much has changed, but then so much is the same, right? There's still some of the big issues that we hear from members with dental insurance and their frustrations with different things like fees and contract clauses and all those kinds of things.
We also are exploring things like Medicare and what that potentially could look like down the road.
Wright: [00:04:20] We're going to get to negotiating in just a moment. But if I may, there's each state has their own, like, legislations, right? That you all have to know and get to know and, and kind of, I guess, speak on each state's behalf, right? So, like, how do you go about that? I guess it's all of you all being at the table that helps give you that expertise, right?
Ioannidou: [00:04:42] And how large is the council? Do you have representatives from each state, I guess? Like, the point that you made, ArNelle, it's very good.
Wright: [00:04:49] I think it's good for our listening community to know about, like, how you do the work that you do because it's really important for our dentists.
Stuefen: [00:04:58] So our council consists of 17 members. So those are representatives from across the country. For example, I represent district 10. So I represent five states. And so I am responsible for understanding what's going on legislatively within all five of those states. I'm not going to say I'm an expert on what it's happening in every single state in my district, but I have the contacts and the ability to gain that and make sure that I'm representing them fully as we show up to council meetings and discuss what's going on across the country.
Bulnes: [00:05:30] Yeah, so I would piggyback. So like a great gentleman at the ADA obviously is Dennis McHugh, who kind of helps us head it up. But also Paul O'Connor with the SGA office, state government affairs office. Every time we would have a meeting, there would be a portion dedicated, you know, a couple hours, maybe two and a half, to what are other states and districts doing? That kind of opens up, maybe, you know, I'm from Florida. I represent the 17th district. That's a one state district. Is that something that maybe we can model in the state of Florida that maybe Iowa is doing or Delaware is doing or Connecticut? Is that something that fits into our state practice act and how we can maybe move that up the ladder from a state standpoint?
I know we'll get into later. Is this state? Is it not state? Does the laws even apply? We'll jump into that a little bit. All right.
Ioannidou: [00:06:17] They sound simple, but I bet they are very complicated, right?
Bulnes: [00:06:23] It is. I mean, I think one of the greatest things I saw from being a volunteer is the diversity of thought. Because different things are happening in Oregon, California than they're happening in Florida. Or in Iowa. We shouldn't be so myopic in our viewpoint of dental benefits. We learned a lot from each other. And I think my exposure to that council grew me a hundredfold to where now I'm sitting on this podcast with you as an expert, because we kind of live, eat, and breathe it, right?
Wright: [00:06:49] Yeah.
Ioannidou: [00:06:50] Yeah, for sure. Let's start with the tough stuff. Let's talk about negotiations, and how do we perceive this, and the process of negotiating. So what exactly can dentists negotiate on their contracts? What is negotiable? I mean, we hear always that everything is negotiable, but is it really the truth?
When you negotiate with insurance providers, how should you go about this as a dentist?
Bulnes: [00:07:14] I've been lecturing on this topic for six years. And there's a distinction between being an in-network dentist and an out-of-network dentist. Obviously an out-of-network dentist is not bound by a contract. Ninety-five percent of the dentists in America are on a plan and they're called in-network dentists, meaning they signed a contract to XYZ benefit group, right?
We're not going to use names here. And now you're held by that contract, which the contract probably is only two pages, but it's not what's in the contract that’s what's kind of causing angst across America. I think personally, if I was a provider looking at getting in a network, I would want to see, number one, their fee schedule, which I do believe most dentists look at that. That's the first thing they go to. They're like, yeah, I can deal with those fees and I can make my practice work.
However, it's the provider manual that they typically don't look at. The provider manual has clauses in them that causes the most angst across dentists. For example, you sign up for XYZ Dental Benefit Group, and all of a sudden you're getting patients from ABC Dental Group.
And you're like, I never signed up for ABC Dental Group. Well, what ended up happening was XYZ Dental leased their network to ABC. And in that contract you signed, you allowed them to do that. Because you never read the provider manual. That's called an All Plans Participation clause or an Affiliated Carrier clause. Those clauses that are in the provider manual, in my opinion, are completely negotiable, but you’ve got to get your hands on the provider manual.
Stuefen: [00:08:54] Absolutely. Yeah. It's the things that the dentist didn't read before they signed the contract that they're surprised by, but it was written there. It just needed to take an extra look.
Ioannidou: [00:09:05] I wonder, is it written like, clearly and explicitly, or is it written in, like, this credit card, small fonts that, you know, you don't pay attention to.
Bulnes: [00:09:15] I think the verbiage on a contract would say second page, please refer to provider manual for all provisions. That's it. So it's pretty clear. It's clear to look at the provider manual, but if you don't request it and you don't get it. You're not reading it.
Ioannidou: [00:09:29] Yeah, that's right.
Wright: [00:09:30] There we go. Yeah. Okay, so that was going to be my next question. I want to make it very clear for our listeners how they can get their hands on the provider manuals, which is by making a request. If you don't mind, either one of you can walk us through how to make that request.
And then, two, people may say, I don't have the time. When do I find the time to read through this provider manual before signing up? And then if you're working in a group practice or a DSO or something like that, if it's already decided for you. So maybe we can tackle a few of those things.
That was threefold. Sorry, guys.
Stuefen: [00:10:04] We'll start with asking for it. So I would definitely talk to, there's going to be some sort of representative, some sort of provider representative that you are in contact with when you're trying to decide if you're going to sign on with a network. And they're going to be your resource for that. And you know, honestly, if they're not going to provide that for you, I would be very wary of signing a contract. You want to know everything that you're getting into before you sign it.
The other thing is. I know you talked about what if I just don't have time, but this is your livelihood and this is the health of your practice. This is something you have to find time for, even if it's the least favorite thing on your to do list. It's so important to know what you're getting into before you sign it. So, find the time.
Ioannidou: [00:10:50] Yeah.
Wright: [00:10:50] I was going to ask, what does the ADA provide in order to help make this a more enjoyable process, if it can ever be?
Stuefen: [00:10:58] Absolutely. One of the things that we've got at the ADA is a contract analysis service. And so that service you can actually take advantage of and they can help you evaluate that contract before you sign it.
Wright: [00:11:11] Awesome. I appreciate it.
Ioannidou: [00:11:12] So just for me to understand, you know, I have spent my entire life working in an academic institution, so I never needed to do this. Usually universities, or especially state universities, negotiate this on a different level, right? But just to understand, so all these contracts come to a standardized template and then delivered to all, and then each dentist negotiates and, kind of, tailors the contract to their own practice needs. Correct. Does it make any sense?
Bulnes: [00:11:43] The contract's pretty boilerplate standard language where the devil and the details is in the individual benefit plans’ provider manuals on how they're going to adjudicate claims. When are they going to pay? When you can and cannot submit a claim? So for example, ADA policy is, the day that you prepare a crown and you take an impression, on impression date, you submit a claim. That's ADA policy. That doesn't mean it's policy across the board. XYZ Dental might say in their provider manual, no, you don't submit the claim until seat date. So if you're not following the provider manual, that's not part of the contract. You're not going to get paid on your impression date. You're getting paid on the seat date.
So there's little intricacies in the provider manual that you need to read. And I 110% agree with Sara. It's your due diligence. It's the livelihood of your practice. I would not buy a home, a car, employ my services without looking at a contract and reading it thoroughly and understanding what it says.
Wright: [00:12:46] All right, everybody. Did y'all hear that? It's your due diligence. And this, we're not waving our finger at you. We're just trying to help and equip you with some tools so that you can, you know, survive.
Ioannidou: [00:12:57] All these are so interesting and kind of tricky a little bit. So I wonder, what is the ADA doing to get dentists higher reimbursement?
That's the hot question that every dentist, from the newly practicing dentists to even more senior people that perhaps never read their contract, how does the ADA help? And we asked the ADA's resident dental insurance expert and this is the answer that we got.
McHugh: [00:13:24] Hello. My name is Dennis McHugh and I am the American Dental Association senior manager for third party payer issues and I have been with the ADA for 23 years. My department assists member dentists with questions and concerns with their patient's dental insurance plans. A question we often receive is, what's the ADA doing to get me higher reimbursements?
Well, reimbursements are determined by the insurance companies and the ADA cannot become involved in fee negotiations because it could expose the ADA to antitrust claims, which even if ultimately unsuccessful, would be very expensive and time consuming for the ADA to address.
The good news is, we have listened to our members and we've put together a contract negotiation toolkit that members can use to have these discussions with payers. The toolkit provides general information to help dentists with these discussions.
So, when I ask dentists how long it's been since they've had an increase, sometimes they'll tell me it's been 10 years. So, I'll ask them, When was the last time you asked for an increase? And they'll say they never have asked for one. That's why we recommend you ask for an increase on an annual basis. And here's a tip. Circle your calendar at the end of the year or the beginning of the year to have those discussions with the payers.
And if you need further assistance, please contact us at 800.621.8099 or by email at email@example.com.
Wright: [00:14:52] That was good. So Dennis mentioned antitrust. There may be some people, especially some early career dentists out there, who have no idea what antitrust is. Could one of you explain that to us? Very high level, please.
Bulnes: [00:15:07] I can bring it to you on a basic level. Dentist to dentist, we cannot discuss what we charge our patients. That's antitrust. You cannot discuss down the road saying, hey, what are you charging for X procedure? That's price fixing. We cannot do that.
I think if our general dentists would go into their practice management software system and just do a search of their procedures by percentage, they're probably going to find that they have 20 codes that they use most often. Everything else really doesn't matter.
So if I were to look at contract negotiation, I'm not looking at the entire fee schedule. I'm looking at the 20 codes that are in my cache of what I provide to my patients. That's what I'm going to hone in on. I'm not going to worry about the one I do once a year or one every two years. That's not helping my patients. That's not helping my staff put bread on the table. Identify the codes that you use most often and really hone in on those. And always ask for an increase. They can only say no.
Wright: [00:16:04] And I love how he gave us the advice to do this annually. So everybody out there, you want to make sure that you're asking for those increases annually.
So here's the other part of that coin, or the other end of the spectrum, is some people want to know when is the time to walk away? Is there a right way to break up with your network or your provider? So why don't we tackle that? That's a sticky, sticky conversation.
Stuefen: [00:16:29] Yeah, I've been there. I've done that.
Sometimes you decide this just isn't working out and we need to break up, right? So how are you going to do that? Well, you need to look again at that provider manual that we talked so much about. It's going to tell you what kind of notice you need to give to that insurance company. So it's probably going to be 60 days, 90 days, something like that, that you're going to have to give them notice.
It's not like you can call them up and say, hey, I'm no longer in-network and it's done that second. There's going to be a little bit of time, but that's okay. Because I think you want to have some time explaining what's going to happen to your patients. You want to make sure that you can have that one-on-one conversation with those patients so that they're not surprised by it.
So personally, my experience is that 60-, 90-day window, or even longer if you plan farther out, is really beneficial so that you can have that time to talk to those patients and let them know. And also make sure that you let them know that Yes, maybe I'm going to be out of network, but you still have benefits and here's what they're going to be and so that they're not so scared. Because I think sometimes patients hear oh, you're not in my network. And they just kind of assume that they're not going to have any coverage, right? So being able to have that conversation with someone that they trust, I think, makes a big difference.
Bulnes: [00:17:47] Yeah, I one hundred percent agree, Sara. And definitely say you kind of said, you know, call them up. It's never a phone call to do a breakup. Maybe personally, but not with the dental insurance company. You're going to have to send some type of letter. I would do it Certified to the appropriate address. Do it Certified so that you know they got it. Okay. You can do snail mail now. Through emailing, make sure it's a returned receipt that you know that person got it.
It's very important to know if you're in- or out-of-network, you don't want to get caught where you thought you were out-of-network and you're charging out-of-network fees. But you're in-network. That could cause a lot of confusion, which goes to refunds and things of that nature.
Wright: [00:18:27] Can you touch on that a little bit? So like, how is it that a doctor could think that they're out of network? Give us a scenario of where you think that you're out of network and you're not.
Bulnes: [00:18:36] So in my experiences that I've dealt with, these offices had either faxed a form back, and thought they were out of network. And this might go on a year or two, and they never were.
They kept identifying them as providers. Patients were coming to them as providers. And it could be an awkward and sticky situation because you're charging one fee, a lot of confusion. Patients don't typically like that. So that's where you want to get someone on the phone. You want to talk to them.
I mean, this is a breakup. I mean, this is a major decision you're making. You definitely want clarity on where am I sending this? Okay. What's my final date? You received it. Yes. What's my final date? And that's when you know, that's when you're off the network. If you're not getting the information, you probably didn't file the right way. Whether the written request or email, it's never going to be a fax. You're never going to fax something. That's not the way to do it.
Ioannidou: [00:19:25] Do people fax things nowadays?
Wright: [00:19:28] I was literally going to say the same thing. Like, I know how to use a fax machine.
Ioannidou: [00:19:32] I don't think we have a fax machine. Do we have fax machines anymore?
Bulnes: [00:19:35] So pro tip, fax is HIPAA compliant. So I fax. I fax things. When you send it, you don't have to send it in a secure fax lock box, like we have to do emails where they have to put a login in. It's an effective way to communicate that's HIPAA compliant, if you have a fax machine.
Wright: [00:19:52]: Nice. That is a pro tip.
Yeah. We'll be back.
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Wright: [00:20:45] We have Dr. Chris Bulnes and we have Dr. Sara Steufen with tips and tools to help you become a negotiating pro.
Ioannidou: [00:20:52] The whole process of breakup must be an intimidating process, right? Perhaps that's why people avoid this semi-confrontational experience, maybe? I don't know what it is, but I bet it's intimidating, isn't it?
Stuefen: [00:21:06] Yeah, it is for me. I felt like when I was starting to evaluate some of the networks that I was in, and considering that breakup, I almost felt like I was abandoning my patients, right? So I'm emotionally attached to these patients. I've been seeing them for quite a long time and it's hard. It's a hard decision to make and you start running reports and going, okay, if I leave this dental insurance company, how many patients is this going to be that I, potentially, I'm going to miss for my practice?
And then you start seeing the names. You go, oh no, I don't want to, I don't want to do this to this person. But at the end of the day, you have to, you have to look at the health of your practice. And if your practice isn't healthy, it's not there and able to provide dentistry for the community, then you're not going to be able to see any of your patients. So it is, it's definitely for me, each time I've kind of made a decision like this, it's been emotional, but you have to put it all together. It can't just be the emotion, right?
We've got to look at the health of our practice. And remember that we're providing not just for, like, me personally as a dentist, but my staff. They all have to be able to take care of themselves too. I want them to be able to take care of their family.
So I will say one other story about a breakup that I went through. The insurance company actually came back and said, well, hey, we'll give you a much higher fee schedule if you choose to stay on. And so that's something that you have to be prepared for as well. You may be surprised by the fee schedule that's offered to you. Now in my situation, I was ready to go. I had already kind of come to terms with what I wanted to do and, and I was ready to be done. But that's a possibility that you should be prepared for.
Ioannidou: [00:22:50] Okay.
Wright: [00:22:51] Both of you have said, you've mentioned the statement, the health of your practice. How would you describe that? Because I bet there's a listener out there who may say, but what about the people who need you to be in-network? You know what I mean?
Bulnes: [00:23:02] I think identify the patients that are in the company that you are looking to break up with. Are those patients benefiting your practice? It's very simple. If you're seeing a lot of patients for emergency visits from a certain dental plan. Are those the patients that you want? Are those your recall patients? Patients that are doing comprehensive dental care?
Or are they not those patients? You might be surprised when you do that analysis over your dental plans of where are the good, because there are good plans. And where are the ones that maybe aren't benefiting your practice? Because you're not seeing, number one, a lot of patients from that dental plan. You're just on that plan. And they're not benefiting the practice the way you thought they were.
Ioannidou: [00:23:43] So I'm not in practice. I'm in academics. We always teach the students how the patients benefit from our treatment and our prevention approaches. So I guess for me, it's really tough to balance and I completely understand it. The private practice, it's a financial entity that you have to protect and it's your life good as Sara mentioned earlier. So how do you balance the needs of the patient and your financial health of your practice?
Bulnes: [00:24:13] I'm betting, because I know Dr. Steufen very well, that probably some of the patients that she broke up with their plan, they stayed with her. Because they like her. Because there's always the option in dentistry to go out of network. And there's really not a big, it's not a catastrophic loss. It's not like medical where we're talking, it could be a million dollars, If you go to the hospital, if you go to an out-of-network hospital versus in-network. The benefits aren't as robust, that it's going to break the bank for a patient if they come see you out-of-network. It's only like a five to 10 percent split.
And I think the value is, for Dr. Stuefen and for myself, is that they're coming to see us. And I think if you outline it, to the benefit of what they've gained in your practice, and the small difference from going out-of-network to in-network, I'm betting more than half are going to stay with you and you're still being able to provide the care because they respect what you do and they like your practice.
Ioannidou: [00:25:08] I love it. Yeah, this is great. We have been hearing a lot about the Employee Retirement Income Security Act. What is it? ERISA? Yes. I like this. ERISA. Sounds like a female name.
Bulnes: [00:25:21] That's somebody I like to break up with.
Stuefen: [00:25:25] Exactly.
Ioannidou: [00:25:25] Very good. That's great. Definitely. So, can you explain what it is and how all dentists can find out which laws their state has and how they apply to their life and to their reality?
Stuefen: [00:25:42] Oh, this is an easy one. This could be, this could be a three hour podcast. So ERISA stands for the Employee Retirement Income Security Act. It's commonly called ERISA, that's the initialism of it. It's a federal law that regulates employee benefit plans, including those for dental care. So in general, dental coverage is separated into plans that are defined as either self funded or fully insured. This distinction determines how the plan is regulated, whether it's federal or state.
So the confusion that happens is that ERISA plans claim that they don't have to follow state insurance law. And so when you are dealing with an insurance company, you don't know whether or not it's ERISA or not. And you're looking at an explanation of benefits and you're going, well, why didn't this company follow our state's non-covered services law, for example. And the reason is probably that they're claiming an ERISA exemption. Clear as money.
Bulnes: [00:26:46] So classic example is you send off a claim. You would like payment to come to the dental office, not to the patient. Well, they keep sending it to the patient. And then what do you do as an office? You call them.
Hopefully it's not around the holiday because you're not seeing it. So you're tracking down money because they're sending the payment to the patient, not to the dental office. But you would have to say, you know, but our state law says it has to send it to us, if we check that box on our claim form. But if it's an ERISA plan, they don't follow the state laws, and what they do is they send it to the patient, and then you're chasing it.
That's a classic example. I think you all alluded to dentists being confused about how ERISA impacts state laws that apply to them. The ADA has a special committee. Sara and I sit on that, that we are both part of, and it's working on strategies to move the needle on ERISA. The ADA is working with state dental societies to see that dental insurance reform laws already on the books are being properly enforced. So that's kind of where the ADA is presently on ERISA.
Wright: [00:27:46] I have so many questions. I feel like I'm sorry, and I don't want to keep you guys here.
Stuefen: [00:27:49] I love it. Go for it. Yeah, that's what we're here for.
Wright: [00:27:53] Where can our listeners find more about this issue, the whole ERISA issue. And then the second thing I'd like for you to tackle is for our doctors that are working in dental support organizations, I think knowing about these laws is really, really important. And maybe you can just kind of speak, really quickly, about just the significance of this and how it's still relative to that demographic of doctors. And I'm just thinking along the lines of, like, our previous conversation with Marco, how we outline how the landscape in dentistry is changing, how the practice modality is changing. And so I just kind of want to weave a little bit of that in there.
Stuefen: [00:28:31] So if you want to find out more about ERISA, the best place to go is ADA.org/ERISA. That's ADA.org/ERISA. And there are a whole lot of resources there on understanding this more. And we're planning to add more information to it as we continue to work on this topic.
Bulnes: [00:28:53] Yeah. And as far as the DSO dentist that signs a contract to work for DSOs. I've never worked in a DSO, but my guess is that they don't have any power in picking what benefit companies they will work with or will not work with. You know, they're signing an employment contract. The DSO is figuring out, in their practice model, and how they feel their health of their large practices.
These work best in our group, the DSO and in you, the employee. This is what you'll take upon agreement of your contract. Now, I guess the dentist could go deeper into their contract and exclude some and say, I'm not signing a contract if I don't, I'm not seeing these patients. I don't want to see this network. But that would take a lot of legwork.
And I understand the strife that young dentists or dentists coming out of school, they're probably not going to go to that because they want to get to work. And that would take a lot of time.
Stuefen: [00:29:47] And another thing to add, if you don't mind. It is important to understand these rules, even if you're not the one that's dealing with the administrative part of the practice. Because you're probably being paid on production or some sort of compensation method. And if you're taking a look at how a patient, or what your monthly production or collections look like, you need to understand how that was affected by the insurance plan.
And so this is important whether you're an owner dentist or an employee dentist. It really doesn't matter what field you're in.
Wright: [00:30:28] There you go. Awesome.
Ioannidou: [00:30:29] I guess we should all go and look at our plans, right? I have to look at my plan now. Now I'm curious.
Wright: [00:30:35] Some of those questions, I'm not going to lie. Asking for myself.
Ioannidou: [00:30:39] Right? So where can listeners learn more about this issue? I know that Sara, you mentioned this, but let's make sure that we have it clear.
Bulnes: [00:30:48] Very simple. ADA.org/dentalinsurance or /dir.
Ioannidou: [00:30:54] Very simple and very useful, I guess. So what is the latest news and trends in the dental insurance industry? Any changes in the horizon this year? Anything that we should be prepared for?
Stuefen: [00:31:08] Lots of dental insurance reform is happening. We hear from dentists that there are things that need to be changed and that the ADA needs to help them. And that's what the ADA has been doing, is really focusing on helping states with dental insurance reform.
So in the past five years, we've had over 130 state laws that have been passed helping dentists and dealing with dental insurance in some form or fashion.
Ioannidou: Wow. 130.
Wright: What a heavy lift.
Stuefen: It's pretty awesome. And I think we're just going to have so much more.
Bulnes: [00:31:45] To piggyback inside those, we have about 24 states that are giving, now, the doctors choices on how they'd like to be paid. Is it electronic funds transfer? Is it virtual credit cards? Would I still like a check? And then almost half the states, we kind of touched on leases, but now half of the states have passed legislation to give the dentist the option to opt out of network leasing. So that's a win. Now remember, those only cover the fully insured plans, not the self-funded ERISA plans.
Stuefen: [00:32:13] So I did want to mention as a resource a couple things that will kind of help put together everything that we talked about. One is our fee negotiation toolkit, which is available on the ADA website.
And the other one is a toolkit that was just released by the Council on Dental Benefits, which is terminating a network agreement and what to take into consideration with that. So both of those are available at ADA.org/dentalinsurance.
Wright: [00:32:39] All right, so it's going to behoove everybody again to make sure you do this research.
Take the pointers that we have from our podcast and do your research. Make sure you're reading up on those documents.
Announcer: [00:32:52] On the next Dental Sound Bites.
Wright: [00:32:55] Whether you're in job search mode or looking to start fresh, learn how to manage the big challenges like relocating your practice, your license, and your life. What you need to know before you make your next career move.
Thank you all so much for giving up your time being here on the podcast with us and for the work that you're doing on CDBP. Can you please tell our listeners where they can find a little bit more about you all in the ADA's dental benefits council?
Stuefen: [00:33:23] I would go to ADA.org/dentalinsurance.
Wright: [00:33:26] Okay, there we go. Well, if you can't get enough of this topic, we did do another episode on dental benefits back in season one. It was episode eight. And we talk about insurance pitfalls, submitting your fees and your EFTs. Make sure you go and check it out.
Ioannidou: [00:33:41] Thank you. Thank you, guys. This was very, very interesting. I learned so much.
Stuefen: [00:33:46] Thank you.
Bulnes: [00:33:47] Oh, my pleasure. You're welcome.
Stuefen: [00:33:48] Definitely. An honor to be here.
Wright: [00:33:50] Thank y'all.
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Ioannidou: [00:34:04] And don't forget the conversation continues on the ADA Member App. Catch all the exclusive bonus content and what you didn't hear on the show.
Announcer: [00:34:14] Thank you for joining us. Dental Sound Bites is an American Dental Association podcast. You can also find this show, resources, and more on the ADA Member App and online at ADA.org/podcast.
The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the views or positions of the American Dental Association.