Delta Dental Accidentally Paid For Crown Procedures For Many Patients
A system error at Delta Dental of California led to the insurer accidentally paying for crown procedures for a large number of patients. The California Dental Association reports that around 350 self-funded employer groups benefited from the error.
Delta Dental paid for crowns that it technically was not required to cover on claims filed from October 13, 2018, through January 10, 2019. The insurer’s policies place a five year limit for replacing crowns. Under normal circumstances, patients must pay for dental services prior to that five-year limit passing.
Delta Dental has Sent Out Adjusted Claim Statements to Some Dentists and Enrollees
Those who haven’t received the adjusted statements should soon. The new statements are being sent out to nearly 1,000 dentists in California, and they began receiving them the week of October 21, 2019.
Dentists who have received an adjusted claim statement from Delta Dental have two choices. First, they could refund the insurer and then contact patients for proper payment. Or they could file a dispute with Delta Dental.
If a dentist is seeking to file a dispute, they must do so within 30 days of receiving the notice. The following crown procedure codes resulted in overpayments: D279-D2792 and D2750-D2752
If a dentist does not file a dispute and does not refund Delta Dental, the insurer can legally deduct the amount overpaid from future claims. They can begin doing this 45 days after the dentist has received the initial adjusted claim.
A Major and Costly Mistake for Delta Dental
In some cases, dentists may no longer be in contact with patients who had their procedures accidentally paid for. This accident may force Delta Dental of California to deduct the owed amount from future payments, which hurts the dentists. The dentists have the option to file a dispute, but it’s most likely that the dispute will not do anything but slow down the process a little.
All of the affected plans were self-funded. That means they’re bound by the federal Employee Retirement Income Security Act rather than California-specific insurance commission laws.
Dentists filing disputes will need to demonstrate that they made every attempt to verify the patient’s benefits. If the provider can show that they were charging Delta Dental based on the plan information provided directly from the insurer, they may be able to win their dispute.
We hope this article helped you achieve a better understanding of the system error at Delta Dental of California. If you’re looking to learn more about how to help your practice grow – don’t forget to download our FREE 43-page Report on Increasing Case Sizes and Collections.