Claims pile up under state dental plans
URBANA — When Jackie Hunter of Mansfield went for a dental cleaning last July, she paid for it herself and waited for her insurer to reimburse her.
She's still waiting.
In fact, Hunter, an administrative assistant in the University of Illinois human resources office, doesn't expect to be paid back for the cost of her cleaning until May, she said.
The state's dental plans, administered by Delta Dental of Illinois, are self-funded, so claims are paid when the state has the money.
And state employees and their dentists know the wait can be long as the claims pile up.
Outstanding claims owed to state employees and dentists, as of Friday, totaled $66 million, according to Anjali Julka, a spokeswoman for the state's Department of Central Management Services.
Every part of the state budget is being squeezed because of increasing state pension obligations, she said.
For now, payment on claims through the state's Quality Care PPO and Premier plans are running 13 weeks behind for Delta Dental's in-network dentists and 35 weeks for out-of-network dentists, according to Delta Dental of Illinois.
In-network dentists agree to accept certain fee arrangements and are paid directly by Delta Dental. Out-of-network dentists charge their normal fees, according to Delta Dental of Illinois spokeswoman Ann Marie Walker.
As of last August, a new state law (Public Act 97-1086) allows for state employee patients to assign their payment of benefits to an out-of-network dentist — though the dentist doesn't have to accept it.
If a dentist agrees to accept an assignment of benefits from a patient, the dentist assumes the wait for the payment and can only collect at the time of service for the uncovered portion of the bill.
Savoy dentist Dr. Larry Tschopp recently agreed to be the one doing the waiting for payment on behalf of his patients, head dental assistant Megan Ward said.
It used to be the other way around, she said, but the practice was losing patients.
"Unless the patients want to wait, because they do get 9 percent interest," Ward said.
The state is paying dentists and patients interest at 9 percent annually on its backlog of dental claims, from the 30th day after receiving the claim through the day the claim is paid, Julka said.
The interest payments are made when the claims are released, and all interest payments must be made within 30 days of a claims payment, she said.
For Hunter, the last nine-month wait on a reimbursement of a $196 dental claim got her an interest check of $10.73, she said.
"And it's a separate check, and I'm sure there's a reason they have to do that, and I'm thinking how efficient is that," she said. "It probably comes from a different fund."
Dionne Haney, director of professional services for the Illinois State Dental Society, said the state payment lag has been a problem for several years, and it's increased for out-of-network providers.
Even in 2011, the state was six months behind on payments, she said.
In contrast, private insurers generally pay on dental claims in two weeks, Haney said.
An in-network dental office for Delta Dental, Hessel Park Family Dentistry in Champaign, is generally getting payments for state employees in about 60 days, said Lauren Carter, a business assistant in that office said.
However, she adds, "there doesn't seem to be any rhyme or reason to it. We have some claims from September that haven't been paid."
Urbana dentist Barry Howell, who also hasn't opted into the Delta Dental network, said state employee patients seem to understand it's a state issue and don't blame the dentists.
Still, he said, "it affects my patients because of the way the state has constructed the rules."