Insurance companies have been employing a number of strategies to delay prior authorizations and payments to dental practices, which can put financial strain on providers.
From inconsistent responses to claiming to have never received documentation to dragging out payment, dentists need to fight against insurers’ policies, according to Robert Trager, DDS.
Dr. Trager, who practices at JFK Airport in New York City, recently connected with Becker’s about how insurance companies are harming dentists and their practices.
Note: Dr. Trager’s response was lightly edited for clarity and length.
Question: What is one economic or policy development keeping you up at night, and how are you preparing for it?
The policies of most of these, if not all insurance companies, have been very deceptive, deceiving and unfriendly to the dental profession. The employees that are hired by these insurance companies are not properly trained. There are many inconsistencies in the information given to the provider. One insurance representative will say one thing and another will give a completely different answer. As an office who has dealt with insurance companies for more than 40 years, we know what the requirements are for different procedures that need pre-authorization. Recently, my staff contacted an insurance company for assistance in the status of an outstanding dental claim and was given one explanation. On the very same call, my staff requested to speak with a supervisor in the U.S. and the very same question was asked in the same way and a different response was given. It’s sometimes hard to keep track of what’s acceptable and what’s not.
We are here to help the patients, as most of them come to their provider for information about their benefits plan because they don’t understand the insurance jargon. We speak to them in laymen’s terms. It’s upsetting when the provider sends all the information needed to get pre-authorization for dental work that we know needs attachments; we send everything the insurance company needs; follow up in a timely manner only to be told that the insurance company didn’t receive the information needed for the pre-authorization. Many insurance companies try to delay, delay and delay.
These insurance companies have the philosophy to hold on to their funds as long as they can. They tell the provider that it will take 30 days to process the request, which once, again is a stall tactic. Each time the provider calls the insurance company for the updated status of a claim or pre-authorization update the response is 30 days to process the provider’s request. Sometimes the original request was done; 30 days have elapsed and now they are saying it will take another 30 days. Another request for status and they will say it will take 30 days to process and because it’s under review and now, we are way past 30 days from the original case and in some situations it has been months.
These insurance companies are finding ways to avoid compliance with the dental loss ratio and lease back agreements that are mandated by many states. We as a profession must come up with our own methods to outsmart these insurance companies.
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