Did you receive an email from the Bridge to Healthy Smiles campaign today? It reminded local voters that Illinois Governor Pat Quinn and the State Legislature are conducting a review of all Medicaid services to find $2.7 billion in budget cuts. Adult dental services are on the chopping block for possible elimination due to their classification as “optional services” under federal reimbursement guidelines.
The Bridge to Healthy Smiles campaign urged voters to help the governor and their elected officials understand that elimination of the adult services is not the answer; it will instead shift the burden to emergency rooms that can not treat the underlying dental condition.
You can read the full message from the Bridge to Health Smiles campaign here.
If you agree and want to help, the Bridge to Healthy Smiles campaign encourages you to call Gov. Quinn and your legislators and explain why they must not cut the adult dental funding and what the impact will be on the underserved population.
Governor Quinn’s office can be reached at 217.782.0244 during business hours.
The Illinois State Dental Society has provided on its website links to help you identify your elected representative, and an outline of talking points for when you call that person’s legislative office:
- The adult dental program is a state-optional program and only accounts for about 20 percent ($51 million) of the entire dental appropriation in the FY-12 budget, which is projected to be $300 million. Since the federal government pays half of the Medicaid costs, the State of Illinois’ savings would only be $25.5 million.
- If the adult dental program is eliminated, much or all of the savings in the dental appropriation would be offset due to increased State spending for those patients who present to hospital emergency rooms seeking pain relief.
- In most cases, emergency rooms are only able to provide pain medication and antibiotics, which temporarily address the clinical concerns.
- The Pew Center issued a report on February 28, 2012, that documented a 15.8 percent increase in emergency room visits from 2006-2009 in states that reduced or eliminated adult dental care programs.
access to care
state of illinois
Want to know more about the dental benefits industry? Then
consider attending the ADA's
National Dental Benefits Conference, held Friday and Saturday,
August 28-89 in Chicago. Registration is free but must be done in
advance of the conference.
As an added bonus for dentists who attend the conference, several
of the presentations are eligible for continuing education
You will hear from representatives from the dental benefits
industry on topics such as:
- Direct Reimbursement: The Debate - Roger Schultz of
BenefitStream and Andy Almeida, a consultant from Mercer, will
discuss the advantages and disadvantages of Direct Reimbursement
and will be available to answer questions from the audience.
- Administrative Cost Reductions - Hear how insurance carriers
are cutting administrative costs including eliminating the need for
dental offices to submit radiographs for claim adjudication.
- Real-Time Claims Adjudication - Hear from experts on the future
of real-time claims adjudication and how debit cards are being used
with dollar based employee benefit programs.
- Workers Compensation & Dental Claims - Ever wonder how
workers compensation carriers handle dental claims? Learn how at
There are a lot of interetesting presentations at this dental conference.<br /><a href="http://www.bcdentalcare.ca/NewPatients/tabid/472/Default.aspx" rel="nofollow">Dental Richmond Hill</a>
Posted by: Dr. David Cheng (email@example.com) on 05/16/2011
Crain's Communications has posted an
article on how dental benefits are faring in the economy. The
article cites a survey
conducted by CDS last fall that found 22 percent of Chicagoans
had a family member with an untreated dental issue and almost half
were without insurance.
In addition, the American Dental Association reports that its
survey of members has found "dentists' decreased incomes and gross billings
decreased in the fourth quarter of 2008 vs. the third quarter."
First-quarter 2009 statistics do show "a small improvement," the
news is still bad, said Wayne Wendling, managing VP of the ADA's
Health Policy Resource Center, to
However, employers and employment consultants are saying that
dental benefits coverage--and employees' use of the benefit is
"While we hear
from dentists that the amount of work being done is less than it
was last year, our claim activity does not show that,'' said Jon
Seltenheim, senior vp of customer service operations at dental
insurer United Concordia Cos. Inc. in Harrisburg, Pa.
"The dentists that I speak with are saying they are having fewer
requests for cosmetic procedures and in some cases are seeing
openings in their hygiene schedules, which they rarely see, but
it's too early to have any strong conclusions. Hopefully, we'll see
some clarity in the middle part of the third quarter," Mr.
One insurer tells reporter Louise Kertesz that fear of layoffs may
be spiking demand for preventative dental services:
Chris Swanker, VP
of group dental and vision for New York-based Guardian Life
Insurance Co. of America, said the industry's emphasis on
preventive services, plan designs that stretch benefits-including
allowing annual maximums to roll over-and fears of layoffs are
"driving a fairly substantial increase in utilization...."
Mr. Hirschberg said there has been "some trail-off'' in use of
higher-cost services such as orthodontia, which is covered at 50%
up to a certain maximum. "There's a slowdown, not that it fell off
the ledge," he said.
the full article
. Related: the ADA will be hosting its annual
Dental Benefits Conference
in August in Chicago. Attendance for
members is free.
Slate reporter June Thomas
blogs about Sonia Sotamayor's $15,000 bill for her dentist.
While some members of the media have been atwitter over this
expense, Thomas suggests the only thing unusual is that Sotomayor's
dentist allowed her to run up a tab:
[I]t's pretty easy to spend $15,000 on dental
treatment. Dental plans generally cover between 50 percent to 80
percent of restorative treatments (crowns, etc.), and most plans
have an annual reimbursement cap of around $1,500-$2,000. If you
need something more than a cleaning or a filling, you're going to
be digging into your own pocket, whatever kind of coverage you
have....If there's anything surprising here, it's that the dentist
allowed Sotomayor to run a tab that big. Most practices would
require cash-or credit card-on the nail. So
Susan Piha, manager of research and education for the Illinois
Workers' Compensation Commission, asked CDS to share the following
news release with members.
The commission has an exhaustive FAQ that
should help answer questions. For more information on the fee
schedule, follow the links on the
commission's home page. Otherwise, call the commission at (312)
814-6611 for more information.
By law, all medical treatment provided to a workers'
compensation claimant on or after February 1, 2006 is subject to a
fee schedule. A provider is still free to contract with payors for
different payment terms but, in the absence of a contract, the
provider will be paid according to fee schedule.
By law, a fee for each procedure was calculated for each
three-digit zip code in Illinois....
When the IWCC lacked sufficient data to calculate a fee, the law
provides that such bills shall be paid at 76% of the charged
amount. Dental services that are billed with ADA codes, for
example, are paid at 76%. Services that are billed with CPT or
HCPCS codes may have fees. Refer to the online fee schedule.
The fee schedule amount is considered full payment. Providers may
not seek to obtain the difference between the charged amount and
the fee schedule amount from the injured worker or the employer.
Balance billing for workers' compensation claims is now illegal
pursuant to 820 ILCS 305/8.2(e).
The law also provides that the payor shall pay the medical provider
within 60 days of the date the payor receives a bill that contains
substantially all the required data elements necessary to
adjudicate the bill. The provider may charge interest of 1% per
month. If you cannot resolve disputes regarding payment with the
payor, you should ask the patient/injured worker to request a
hearing before an IWCC arbitrator regarding unpaid medical
The Illinois Workers' Compensation Commission operates the court
system that resolves disputes regarding workers' compensation. It
does not pay the benefits. In most cases, insurance companies pay
benefits on the employers' behalf.
state of illinois