17
Volume2 Issue3
|
CDA
at
W
ork
Dr. PaulCameron
Hasyouroffice
experiencedanaudit
byan insurancecarrier
that leftyou feeling
uncertainaboutthe
process?Doesyour
frontofficestafffind it
challengingtodealwith
electronic fundtransfers
whenaccepting
assignmentofbenefits?
Anewly formedCDA
workinggroupheld
itsfirstmeeting in
February2015to look
intotheseandother
challengesassociated
withthemanagement
ofdentalclaimsand
benefits.
CDA Spotlight
DENTALCLAIMSANDBENEFITS
We spokewithDr.Paul
Cameron,CDAboard
memberfromNovaScotia
and chairof theCDA
WorkingGrouponDental
Benefits, tofindoutwhat’s
on thegroup’sagenda.
Q
Q
Q
Q
Q
Whywas thisworkinggroupondental
benefitscreated?
For anumber of reasons. Dental benefits
weren’tmuchof an issueabout 10years ago;
dentistsweredoing thework, submitting
claims to insurancecompanies, insurance
companieswerepaying theclaims and
everyone seemedprettyhappy.
But thencompetitionamong insurance
carriers increasedand, naturally, they looked
forways tocut costs. Initiallycost-cutting
measures focusedonpharmacybut now
theattentionhas turned todentistry,which
represents the second largest expense for
insurancecarriers. And this is starting to
createproblems. SoCDA identifiedaneed
todealwith these issues andestablished the
workinggroup.
Who ison theworkinggroup?
Thereare4of us: Dr. TimothyGould from
Vancouver, aperiodontist andco-director
ofmember services at theBritishColumbia
Dental Association; Dr. Gurminder (Mintoo)
Basahti, ageneral dentist fromAlberta;
Mr. AlexGlazduri, director ofmembership
services andmarketingat theOntarioDental
Association; andmyself as chair. I’mageneral
dentist inAntigonish, a small town inNova
Scotia. Soweendupwith somebroad
geographic representationandpeoplewho
bringawide rangeof expertise to thegroup.
Whatsortsofbenefits issuesaredentists
experiencing?
Oneof theproblemswe’vebeenhearing
about is that some insurancecompanies
areveryaggressive in their audits.We’ve
heardabout auditorswhowerequite
unreasonable inwhat they’reasking from
dentists for the sakeof theaudits. Someof
the insurancecompanies interpret patient
consent tomean theycanfindoutwhatever
information theywant onapatient’s
chart;we’re sayingno, youcan’t—youcan
verifywhatwasdoneon that day for the
procedure that hasbeenclaimedby the
patient.
Therearealso some issues associatedwith
electronic funds transfers, or EFTs,which
were introducedby insurancecarriers as
another cost-cuttingmeasure. I thinkEFTs
areagood thingand theywill bebeneficial
for theprofessionover the long term. But
right now, I think they’vebeen introduced
inaway that’s causedproblems for
manydentists across thecountry, suchas
burdening themwithextrapaperworkand
costs.
Canyouelaborateonwhatyou think is
wrongwithaudits?
Theproblemwithaudits is that theycan
bevery intrusive. Theyarenot conducted
ina standardizedwayand sometimes they
put thedentist inaprecariousposition. For
example, anauditor cango intoadentist’s
officeand request apatient’s chart. The
dentistmight provide thewholechart—
not knowing that itmaycontainpersonal
health informationabout thepatient that
an insurancecarrier hasno right to see. Soa
dentistmight unwittinglyviolateapatient’s
right toprotect their personal information.
Whatdoes theworkinggrouphope to
accomplish in theshort term?
We’ve tried to identify themain issues
affectingdentists andprioritize them.
Our top3priorities are toworkwith the
dental benefit industry todevelopan
understandingof best practices for anaudit;
workwithcarriers tohelp them roll out EFTs
inaway that doesn’t unnecessarilyburden
We’ve tried to identify themain issues affecting
dentists and prioritize them.
