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Dental Benefits
Claim resolution |
Ongoing problems with an insurer |
Contract review | Welcome to the home page of the CDS Dental Benefits Committee. Our job is to keep you informed of changes in dental insurance that affect your practice and to update the ADA and ISDS on the problems we face with insurance companies. Hot Topic: National Provider Identifier (NPI)Receive a letter recently telling you to sign up for an NPI? We’ve got everything you need to know about applying for one right here. ResourcesThe American Dental Association maintains a Web page with links on dental benefits issues. The ADA has a general complaint form. This form must be printed, filled out and mailed back to the ADA. The ADA also has several form letters available for dentists to use when dealing with third-party administrators or employer health plans. The Illinois State Dental Society has links to the dental benefit handbooks for several large state employers. Frequently asked questions
I am having a problem with a claim with an insurance company.
I am encountering ongoing problems with a particular insurer.
I am negotiating a contract with an insurer.
I want to report an insurer to the Illinois Division of Insurance.
I want to speak with my CDS branch representative about an insurance issue. Claim resolutionIf you have a problem resolving a claim with an insurer, involve the patient. Inform them that their insurance company is not processing claims appropriately and ask them to contact the company themselves. While some may be reticent to place the problem on their patient's shoulders, an insurer may be more responsive to the patient than to the dental office. Failing that, contact Greg Johnson, director of professional services for the Illinois State Dental Society, at 217.525.1406. Mr. Johnson can tell you what your options are for resolving your claim. The American Dental Association also has form letters when dealing with third-party administrators or employer plans. If you want to make the ADA aware of your problems with an insurer, they have a complaint form which you can print, fill out and mail back to the ADA. This form is used only to track dental insurance problems. If you want to speak with an ADA representative about resolving your complaint, contact the Dental Benefit Information Service and Third-Party Issues department at 312.440.2500. Ongoing problems with a particular insurerIf you are encountering repeated problems with an insurance company, make sure to fill out the ADA's complaint form, which you can print, fill out and mail back to the ADA. Please note: This form is used to track dental insurance problems. If you want to speak with an ADA representative about resolving your complaint, contact the Dental Benefit Information Service and Third-Party Issues department at 312.440.2500. You may also wish to contact Greg Johnson, director of professional services for the Illinois State Dental Society, at 217.525.1406. Contract reviewIf you want input on an insurance company's service contract, contact Greg Johnson, director of professional services for the Illinois State Dental Society, at 217.525.1406 and request for a free copy of an analysis done on the dental plan. You may also contact the ADA's contract analysis department at 312.440.2884. There may be a fee for this service, depending on your circumstances. Illinois Division of InsuranceBefore calling the Division of Insurance, be aware that not all dental insurers are under their purview. The division only oversees dental insurers that are fully funded and based in Illinois. The vast majority of patients with dental insurance in Illinois belong to self-funded plans, meaning the employer bears the costs of its employees' dental care. Self-funded plans are more common at large employers. These plans are not under the supervision of the Division of Insurance but of the Department of Labor. The Department of Labor does not involve itself in claim disputes unless there is a discriminatory aspect to them. You can contact the Illinois Division of Insurance at three locations: Illinois Division of Insurance online
320 W. Washington St.
100 W. Randolph St., Suite 9-301 We want to hear from youIf you have any questions not addressed by the information on this page, please click here. |
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