Dental-plan change means more state employees may pay up front
ST. JOSEPH — For 30 years, Bonnie Silva has gone to the same dental office. So she was stunned to learn that July 1 she's going to have to start making her entire payment — even what insurance will eventually cover — at the time of service.
"I called and asked if our plan had changed any," she said.
Yes, it has, she was told.
Silva, 75, of St. Joseph is married to a University of Illinois employee and is on the state's group dental plan.
Already, many dentists ask Illinois state employees to pay at the time of service because the state is taking such a long time paying their claims.
Some dentists, like Silva's, have managed to hold off taking this step. But many will likely have to start asking for upfront payments under the change from Humana CompBenefits to Delta Dental taking effect July 1, said Greg Johnson, executive director of the Illinois State Dental Society.
That's because Delta is offering a new in-network option for dentists, with lower reimbursements, and only those dentists in the network will have insurance checks sent directly to them, he said. For out-of-network dentists, the checks will go directly to the patients, and dentists will have no way of knowing when those checks arrive.
Currently, the state is running about eight months behind on paying claims to dentists, Johnson said.
Being asked to pay in advance is worrisome to Silva, who says a denture replacement is on the near horizon for her.
"I've had them for, it seems, like 10 or 15 years. The last pair was $1,200. I wouldn't be surprised if it's $2,000 or more now," she said.
Paying the full cost of her dental care and waiting months on an insurance reimbursement may well mean going without some dental care, Silva said.
"We probably won't be going at all unless we really have to," she added.
Mike Claffey, spokesman for the Illinois Department of Healthcare and Family Services, said benefits for employees under Delta Dental won't change. Dentists are reimbursed under a fee schedule, and employees are responsible for a $125 deductible and any charges over the fee schedule.
What's new are the two opportunities for state members to reduce their out-of-pocket dental costs over and above the fee schedule, by selecting in-network dentists through the Delta Dental PPO or Premier network, he said.
Coverage is still available for out-of-network dentists, but state employees are being told their costs may be higher with these dentists because those dentists haven't agreed to Delta's fees and can bill patients for the difference between their fee and the schedule-of-benefits fee. Plus, patients may have to pay the entire bill at the time of service.
Johnson, of the state dental society, said the Delta PPO dentists will be getting reimbursements that will average 15 percent less, and for some services, they'll be taking discounts of 30 percent.
Dentists have already been waiting months and months for payment, he said. Now, in-network dentists will be waiting "months and months for less," he said.
"It's important for every dentist to look at this. It's less money and waiting six or seven months to get less money, so dentists are going into a difficult situation here," he said.
State employees looking for in-network dentists may find it a challenge, one dentist says.
"There are not a whole lot of dentists that are in-network with the state plan," Champaign dentist Dr. Michael Trautman said.
His office has several hundred state employees and managed to live with the lag in state payments without asking them to pay upfront. But that will have to change starting July 1, Trautman said.
"Delta is trying to put pressure on dentists to join their PPO network. But we don't feel we can provide the quality of service patients deserve with that kind of payment schedule," he said.
Savoy dentist Dr. Larry Tschopp, another out-of-network dentist who has held off asking state employee patients to pay at the time of service, will also be making the change to payment at the time of service July 1, said his wife and office manager, Carolin Tschopp.
She said their office has 600 or 700 UI patients and is currently holding $65,000 in unpaid dental claims for those patients.
And the payments come in slowly: The state is running 189 days behind, she said.
Tschopp says she and her husband think the Delta in-network reimbursements are too low for them to be able to join the network and still offer quality dental work.
"We'd have to have our hygienist do a cleaning in 30 minutes to make what she makes now. That's not possible and do a good job."
MoreI was surprised they found anyone to interview whose dentist still submitted their claims and waited for payment. After 20+ years our dentist's office changed their policy a few years ago, and we have definitely cut back on care. I can't blame them -- I'm still waiting to be reimbursed for a visit last December (!). Pretty amazing, but reimbursement to Dentists is supposed to be much slower than to individuals. Who can run a business like this?
Now that many Health Alliance and Humana users are being forced into the state self-funded OAP plans, how long will it be before doctors and other health care providers start requiring up front payments of them? Why would providers want to assume hundreds of thousands of dollars in upaid claims from the state?
While it is true that it is difficult to run a business while waiting on payments from the state ... it is also very difficult to run a household this way. My husband and I are both state employees. We have 2 small children that are going to need regular dental care soon. We've already had to take out a small loan to have an oral surgery done. Dental care is too expensive. I find it hard to believe that there are many dentists that can't afford to pay their bills. They do okay as far as I've seen. If you want to be an in-network provider you are going to automatically be chosen as dental care provider for hundreds, possibly thousands of new patients. Feel the state pinch with the rest of us and wait for your check like I'm expected to.
I just had a dentist appointment a week ago, (six-month check up), of cleaning and fluoride treatment. I paid the $133 up front, as I have every six months with this dentist for the past couple of years. I got tired of receiving late payment notices from the dentist, (which I ignored), because it was the state that was tardy in ponying up, not me. So, I started paying for the whole trip at the time of the appointment. The state would usually cut my reimbursement check and send it the week before my next appointment, a six month waiting period, but I got it, eventually.
It's the new deal with the state government. Might as well get used to it.
Tell me again where the 2% tax increase is going? I'm still waiting for reimbursement for covered service received on December 4, 2010. If any private insurer failed to pay valid claims for six months the insurance regulators would shut them down and the Attorney General would prosecute.
Providers sometimes wait when they can, because the state pays 9% interest on the money. If they make you pay up front, you get the interest. I'm surprised a local bank hasn't stepped in and offered to pay out claim money right away in return for receiving the 9% when it comes in, similar to what banks did when California was paying out bills with vouchers that included later interest.
Agreed. People have insurance because they don't have several thousand laying around to cough up for a dentist. I remember when dentists actually pulled teeth instead of doing fee splitting by sending the patient to an oral surgeon. The cost of all health care is stupid, given the huge profit margins at all levels. It is also ridiculous that people are now being forced to loan Illinois money through this type of arrangement. As far as I am concerned, Illinois' credit is no good.
Here we have a whole bunch of people complaining about the state not paying their claims, or paying 6 months late, or not being able to choose the plan they want, and all the problems associated with it. This is Universal Health Care on a small scale, and people STILL chant for it.
The State of Illinois is broke, and it can't pay it's bills or deal with it's debt or curb it's spending. The same goes for the Federal Government but on a scale that is unimaginable.
Here is the straight dope - all these problems above are CAUSED by universal health care. This is what universal health care looks like on a state-wide level. It starts off great, and when the pols realize they promised too much they pull it back, and don't pay the bills, and pay less for care, and raise our taxes, and increase fees, and borrow money, and increase our taxes to pay interest, and pay late, and pay less for care.... see the trend? Just look at what they did to "fix" our work comp problem - Pay less for care. Just look at how they plan on saving money on Medicaid - pay less to doctors. Just look at what they're doing to fix the budget hole - raise your taxes and not pay bills. Just look at what they're doing when they realize they don't have enough money even after raising taxes - borrow money.
"Universal Health Care" is free lunch. There's no such thing as a free lunch.
Delta Dental is not universal health care. Its just another example of employer-provided health care. In this case, the employer in question is the State of Illinois. I have Delta Dental through my employer, who pays premiums on time, and I have never had to pay upfront for services.
Universal health care is not a free lunch. If you investigate the various means by which all other developed countries have found to provide that all citizens have access to health care you will see that. Under universal single payer, which would be what this country would have if Medicare were extended to everyone, a government collects a dedicated tax and acts as insurer for everyone. It is able to use its bargaining power to negotiate the best possible prices for services and has greater power to refuse payment for practices that have not proved to be effective. It does not prevent citizens from buying supplementary insurance for procedures that are not covered. Countries which use this system, like Canada, have much lower per capita expense for health care and better health care outcomes. No, such systems aren't perfect, but outcome measures indicate that it works a lot better than ours.
People in countries with universal access to health care seem much less critical of their systems than some U.S. citizens who have not had the opportunity to benefit from any of them.
I'm not just talking about Delta Dental. I'm talking about our state and federal government being in a massive amount of debt, and continually spending more money than they take in every year. They can't pay their bills, and many times in the debt numbers we hear, they don't even include future unfunded liabilities for Medicare and Social Security. There is no money.
I'm glad they have great coverage in Canada . But California has 3 million more people than Canada, and that's not including a few million undocumented residents.
I'm not talking about Universal Health care in Canada or the UK or France, I'm talking about our current government's inability to handle this task, given their history. This is true for the State of Illinois pension systems, Social Security and Medicare. Above you write "the government collects a dedicated tax," but the problem lies in the government definition of "dedicated." They tax for specific programs, spend the money today "dedicated" for future expenditures tomorrow, and when the bills roll in the money has been spent already. That's where we are now. What happens when you can't borrow anymore? What happens when we can't print anymore money? What happens when the doctors refuse to work for any less money? I guess we'll see.
http://www.usatoday.com/news/washington/2011-06-06-us-owes-62-trillion-i...
What goes around comes around. From a January 27, 1988 Chicago Sun-Times article titled,
"Tax-dollar waste in dental plan charged"
Millions of tax dollars are being wasted on a public aid dental plan that has failed to provide adequate care to patients and fair payment to dentists, a health organization report obtained by the Chicago Sun-Times charged.
The waste stems from exorbitant administrative costs by Delta Dental Plan of Illinois, the dental care provider for Illinois Public Aid Department recipients, and the failure of state officials to hold the company to the terms of its $70 million contract, the report said.
The report, scheduled to be released by the Champaign County Health Care Consumers this week, also charts a dramatic drop in Medicaid dentists in the Delta plan and lax monitoring by state officials.
Delta Dental , based in River Forest, also was taken to task in a separate and harshly worded report by the Chicago Dental Society late last year. That report calls the dental plan "a disgrace to our state . . . horrible, shameful and disgusting."
"It appears that Delta Dental is realizing huge management costs while running a program where services are not provided to those who really need them," said David Rein, task force leader for the Champaign health organization.
Delta Dental is a not-for-profit corporation that provides care to more than 820,000 welfare mothers and babies as well as the blind and disabled. Most patients live in the Chicago area. The corporation recruits dentists who agree to treat Public Aid patients. Delta Dental then pays the dentists for each treatment. It has held a state contract since 1984.
Michael Berger, Delta Dental vice president of government programs, termed the report's charges as "not true" and "unbelievable nonsense."
"We have increased services and benefits, while holding down costs," said Berger, a former director of Public Aid's Medicaid fraud and abuse program. "The problem is that many dentists don't want to treat the poor."
The Champaign report also calls for state investigation of Delta and a termination of the contract. In the report, the health agency charges that Delta:
Repeatedly violated the state contract by failing to do such things as provide enough physicians for patient care, resulting in many Public Aid recipients being denied dental care.
Sat on nearly $6 million in unspent funds while dentists complained about late payments. Because of late and insufficient payments, many dentists refused to accept patients.
Increased administrative costs and overhead by nearly 400 percent over the state's previous system.
The report and Public Aid documents said 40 percent of participating dentists stopped serving Medicaid patients in the first six months of Delta's contract. More have fled during Delta's three-year tenure.
The Champaign health organization report also charges that Delta Dental at times has misrepresented the number of dentists in its program. Delta Dental strongly rebutted all the report's allegations.
Delta Dental , based in River Forest, also was taken to task in a separate and harshly worded report by the Chicago Dental Society late last year. That report calls the dental plan "a disgrace to our state . . . horrible, shameful and disgusting."
"It appears that Delta Dental is realizing huge management costs while running a program where services are not provided to those who really need them," said David Rein, task force leader for the Champaign health organization. [The article is much longer, but I think one gets the general idea from this portion of it]
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