Welcome back to dentistry. Support the podcast. I'm your host, Sarah Beth. And today we're diving into a topic that affects every dental practice. Dental insurance. In 2024, there have been some serious updates and changes to dental insurance policies and regulations  every dental professional needs to know. And this episode, I am going to be talking about these latest changes from top insurance companies. 

How to keep up with new laws and regulations adjusting your dental practice policies. And understanding the impact of these changes on reimbursements and patient coverage. So let's get started.  

First, I want to talk about the latest changes in dental insurance policies and regulations. Three major dental insurance companies, Delta dental, Cigna, and Aetna have introduced some significant updates this year.  Everyone is talking about the credentialing side, but  I want to talk about their updates that are impacting your practice, that you're probably not thinking about. And yes, credentialing is really important and you really need to know where you stand with that.  But there's more, there's more updates. 

There's more advances in technology. There's more things that are coming your way. That your team needs to be trained on. So let's get into it. Delta dental, you are up first.  Delta dental has made two key updates that whether or not you are credentialed. These matter. First they have enhanced their telehealth coverage, delta dental has expanded its tele-health services to include comprehensive consultations. This means dentists can now conduct virtual visits for routine checkups and emergency consultations. This increases access to care for patients and remote areas, or even those who are traveling that normally would come into your practice. This can even extend to those that have mobility issues.  Back in 2020 when all the major shutdowns happened. Dentistry support  was a pivotal. Choice for dental practices. We taught dental practices over a hundred thousand  on how to handle telemedicine, tele dentistry. 

Tele-health. If you need help in this area, please schedule a call with me. No charge. I just want to talk dentistry with you and I'll help you get where you need to be. So many dental practices are leaving tele-health options. Money on the table that you could be collecting. And since Delta has expanded its  telehealth services. To include comprehensive exams. 

I mean, guys, we gotta get this together. We gotta be doing this because this is money. You could be bringing into your practice. To Delta dental has increased coverage for preventive care services, including additional cleanings and fluoride treatments per year. This encourages more frequent preventive care visits, helping to reduce incidents of serious dental issues. 

 If you have a Delta dental patient, don't just check, do they allow do they allow preventive services check. What is all contained in the preventive care for your patients? Even if it's a healthy mouth cleaning, If the insurance company is allowing three of those per year, patients should get that. Insurance has dictated for a very long time. 

Exactly what patients get for services.  Let's change the game here. If insurance is saying you can have it three times a year. Give this to the patient three times a year. Use up those benefits, your patient is paying those premiums every month, every year.  Let them maximize their benefits. Let's take a look at Cigna. 

  Cigna dental's updates are aimed at streamlining processes and expanding access. They have introduced a simplified claims process now. Take this as lightly or as heavy as you want to, but hear me out fully. Cigna has introduced an AI powered claims processing system that significantly reduces the time for claim approvals. This helps dental offices, just like yours receive reimbursements faster, and it reduces the administrative burden on office staff. There are some key things. 

I'm going to talk about  later in this episode. So keep listening.  two Cigna has an expanded network of providers. To include more dental specialists. This offers patients a wider range of coverage of services without the need for referrals. 

 If you are a dental office who is specialty based, or you have specialists in office, This is important for you. This allows your patients to get services covered right away without having to send them out somewhere else or waiting for a referral. Even if you have specialists in office, it also gives a better access to specialized dental care. And improving overall treatment outcomes. 

Let's shift gears and talk about Aetna for a minute. Now, of course, I'm talking about three dental insurance companies, but these are the three big hitters.  There are many other changes on other dental insurances, but we're just covering these in this episode.  Aetna dental has focused on integrating and enhancing their services.   Aetna launched integrated health and dental insurance plans that provide coordinated benefits and lower out of pocket costs for patients. This is really addressing the holistic health management and simplifying the insurance process for both patients and providers. 

They also introduced new digital tools, including a mobile app for easy access to insurance information. Appointment scheduling and real-time claims tracking this improves communication and transparency between the patients and their dental office providers.    I've covered a few of the major updates from the top insurers. Let's talk about how to keep up with the new laws and regulations with dental insurance.  The dental insurance landscape is always evolving and staying informed is really important to running a successful practice. A lot of times I hear dental office managers focusing on the customer service, focus on the patient, focus on the experience, focus on the leadership. What I want you to realize is that even if all of those things are at the forefront of your mind,  Everything is going to come back to how you handle insurance. 

If you understand your billing 100%, if you understand your insurances 100%, if you understand how to present a treatment plan, clearly. Uh, accurately and in such a way where the patient has no misinformation on how their insurance will pay in or out of network.  Your customer service, your patient experience your leadership. We'll all follow suit. You will have very little to worry about if you understand this piece.  

My biggest bit of advice for you. 

If you want to Excel in understanding the laws and regulations that come with insurances. Is to join professional organizations like the ADA, the American dental association. And the national association of dental plans, the NADP they offer regular updates on legislative changes and industry trends. 

Being a member of these organizations can provide you with so many valuable resources and information. I'm not affiliated with selling for them or influencing for them. These are just professional opinions. I have. Number two would be to attend industry conferences, participating in dental industry conferences and seminars is a great way to stay informed. 

These events provide opportunities for you to learn about new regulations directly from experts and policy makers.  Three, I would really encourage you to partner with other third party dental companies. Dentistry Support is an incredible company. We offer a ton of free training, right on our website that releases weekly. 

 If you don't have the funds to attend seminars or  to be a member, Try to seek out some free resources. And our website is a great place to be. We love to collaborate with you on Facebook. You can  join our Facebook group, which is the dental collaborative. We're constantly engaging there. 

 It is a free group to be a participant in. You can post job ads, ask questions, and we often share our free training right in there.  You don't have to pay anything to get this free training. It's just stuff we love to share with you.  

I also think it's really important to stay subscribed, to reputable dental industry publications and online resources that provide timely news and analysis on regulatory changes. 

This makes sure you're always up to date with the latest information. There are plenty of companies that offer information for a fee dentistry support doesn't believe in that we really are for our dental community. So all of the information we train our team members on  is pushed out to our dental community at no charge. 

So always check out our website. You can go to dentistrysupport.com/freetraining Everything is there. You also have a search icon up in the top right hand corner. You can search any topic and it'll pull up. Any of our free trainings visit them as much as you want check out the ones we've gone viral at. 

We've got a few with 500,000 views . And so there's lots of good stuff on there for ya.  

I want to chat about adapting your dental practice to comply with updated guidelines. Here are some steps to help you adjust first, regularly review and update your practices, policies, and procedures so you are reflecting the latest insurance guidelines. Many dental practices have been using the very same financial policies that have been copied and duplicated and made copies of with the word master written in a highlight over the top of it.  That dental practice may have been in existence for 10 or 15 years. But we're using all the same information. 

Take those documents. Convert them into a word document and update them regularly. If you have ever seen literature from any kind of organization that gets shipped to your dental practice, maybe it's a financial company that you deal with where you do third-party financing. They send you frequently updated brochures on purpose, right? 

 Your dental practice can do the same thing. This is version 2.3 200 24 or whatever it is that way, you know, you have the latest information given to your patients. Things are going to change. In your practice, you are going to want to update your patients as those things change. And just imagine there is going to come a time when your financial policies and procedures will need to either go to the court of law. 

You might be in a situation where you send someone to collections. You want to make sure you are always on the up and up.  Also make sure that your staff members are trained on what these changes are to maintain compliance and provide that consistency that I promise your patients are craving.  

Spend time utilizing updated software and digital tools that are provided by insurance companies.  There are several best practices that I'm going to cover that dentistry support uses on a regular basis.  We're going to get to that in a minute.  Just know that dental insurance companies provide specific tools online that helps streamline administrative processes. It makes it easier to comply with all of the new requirements when you utilize these there's a lot of money that is invested into those particular infrastructures.  And they're there for your benefit. 

 These big box insurance companies they're required to meet certain metrics. I utilize those services because their legal team. Is investing in their research and the implementation of these things so that they stay compliant.  When you see something new launch take advantage of it, use it, it's there for your. Benefit it's there for you're using  it's there for your patients. 

So many good reasons.  

I want to encourage you to clearly communicate any changes and insurance policies with your patients. This can be via newsletter.  A posting in your office.  On social media. There's a lot of different ways that you can use to communicate changes to your patients.  From updates to their coverage that can impact treatment plans. To the way their policy might have changed or processing might have changed with the insurance company. This kind of transparency helps maintain trust. And it avoids any confusion that your patients might have  at dentistry support, we follow several best practices that we believe are crucial for managing dental insurance effectively. The first is that we work, our aging claims every 14 days. I know, I have a previous episode that talks all about billing.  I want to reiterate this because I've had several phone calls this week with dental practices that are talking to me about their aging. 

One dental practice in particular has 205 pages. I have dental insurance claims. Uh, their office produces $500,000 a month in revenue. And their outstanding aging was $1.7 million. Over 30 days. That is astronomical. That is. Over three months of revenue sitting there waiting to be collected. That is insane.  At dentistry support, we believe it is absolutely essential to work on aging claims every 14 days to ensure there are little to no claims aging over 30 days. This helps maintain a steady and forecastable  steady cashflow and reduces your risk of loss due to claim denials.  If your staff doesn't have the time to handle dental billing, it's okay to lean on specialized teams like dentistry support. 

However, I do not want you to think it is ever acceptable to pay two and a half, three, three and a half, four, four, and a half percent of collections. Do not let third parties charge you extra to work on outstanding aging claims. This will save your practice. A ton of money. We are a flat fee based company. That is solely based on metrics that we ask you in our calls with you. 

We're determining what our staffing needs to look like, how many hours we need to allocate. There's a lot of things that go into how we charge, but we believe it should be the same dollar amount every month,  we're not charging you extra to work outstanding claims over 30 days. 

That's part of our job. We're also not going to charge you extra. If we have to give our team over time. In your first few months. We know what's coming. We know  this will make our job easier in the future  ultimately our team can work more efficiently and more effectively for you.  

While AI powered claims processing systems offer many advantages. 

There are some disadvantages. Now I just spoke about  a dental insurance company who is implementing  more and more AI powered claims processing.  There are disadvantages and areas that still require human intervention. I have had so many conversations with dental practices about AI and why they should, or why they shouldn't integrate it, or that AI is taking over dentistry.  I have a whole podcast episode. Specifically on AI, go back and listen to it. However for today, I want to talk about a few more things that have come up in conversations with dental practices. First is bias and errors. AI systems can sometimes make errors or exhibit biases. This leads to incorrect claim denials or approvals. It is very important to monitor these systems and address these as they come up.  There is also the metering of claims. 

AI claims processing can be metered at certain times of the month or quarters to benefit insurance companies. Potentially delaying reimbursements,  dental practices need to be aware of these patterns to manage cash flow effectively. I promise you, there are investors at all of these dental insurance companies. And metering of claims is a very real and very true and very current problem that exists. You can actually watch it yourselves. At the end of every month. 

And at the end of every quarter, everybody wants to look really good at those times. So claims are often metered.  

There are times when human intervention is  necessary to ensure accurate claims processing. Specifically with complex claims. AI struggles with complex claims that require detailed understanding and judgment. So make sure that your complex claims are reviewed by your experienced billing staff. So that everything is put on there that needs to be, if you need help with narratives, we have two amazing narrative free trainings with templates that you can use right on our website, dentistry support.com. Forward slash free training search narratives, and you'll get a slew of free content for you. Your narratives are everything they need to be right. 

Check out what we have there.  

The next is appeals. When a claim is denied, it often requires a human touch to appeal the decision effectively. Having a dedicated team for this can improve your success rate and overturning denials.  

The other thing I want to mention is   there are dental insurance companies that you may call to verify benefits for a patient. And they will say something like.  Yes, you can do all four quads of SRP in the same day. You go let your hygienists know. 

She takes care of all four quadrants and the claim gets submitted.  10 days later, you get a denial saying that they will only cover. Two quads in one visit.  Immediately everybody panics. The patients have set. Now they have a $900 bill or whatever the dollar amount may be.  And you don't know what to do.  Here at dentistry support. We screen  and audio record all of our verifications. 

We do that because we seek to hold dental insurance companies accountable. We want them to have to answer if they told us something or if their website said that they would cover something, we take all of those recordings and we use that to appeal claims. We're successful about 70% of the time in doing that. But it takes a lot of work 

we have an amazing call center infrastructure that allows us to retrieve these recordings, save these recordings and make sure that we've got everything on point. We save all of our recordings for 90 days, because we want to make sure that if something did get delayed in claims processing, we still have access to that recording throughout that whole processing time.  

I know this is a lot of information.  But it's necessary for us to talk about it.   It has been really fun to interact with you through text message. If you don't know what I'm talking about in the show notes is the option to send us a text message. You can use that to send us different topics you want us to talk about on the podcast, kudos, 

chat with us, ask us a dental question. It's been fun. I've enjoyed reading all the messages and responding back to you. This very episode came from several questions that were asked and conversations. I'm having. With dental practices on a weekly basis about our support.  So that's all for today's episode, we've covered the latest changes and dental insurance policies with three big hitters regulations and how to keep up with new laws. Adjusting your practice policies and understanding the impact on reimbursements and patient coverage. And some of the best practices that we follow here at dentistry support.  Before we wrap up, let's have our that's good moment. 

Our TGM the key takeaway for you today is to stay proactive and managing your dental insurance processes. Embrace new technologies like AI. But remember that human touch is irreplaceable, especially when dealing with complex claims and appealing those claims. Lean on expert teams like dentistry support when you can and ensure that you are not overpaying for third-party services, stay informed, stay efficient, and always prioritize clear communication. With your patients. And your team. Thank you for tuning in to dentistry support the podcast. 

I hope you found this episode valuable and that it helps you run a more efficient and compliant dental practice. If you have any questions or topics you'd like us to cover in future episodes. Feel free to reach out, use that text option until next time, stay inspired and keep making a difference. And don't forget to follow us on Instagram at dentistry support underscore podcast for more updates and behind the scenes content.  I'll catch you on the next episode.