Claims pile up under state dental plans

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."

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rsp wrote on February 16, 2013 at 12:02 pm

9% annually. I wonder how much that adds up to in total interest payments. Every time the state pays late to its vendors it's paying a penalty. Which is why some people have suggested borrowing to refinance the state's debt and be able to pay on time. Wouldn't it be business friendly if the state could pay it's bills on time?

Sid Saltfork wrote on February 16, 2013 at 12:02 pm

The wait time is 9 months, or longer.  There are no dentists in this area that I know of that will wait for the reimbursement.  By the way, the insurance is not "free" for public service employees.  Another irritating problem is that some dental professionals are lazy in processing claims for the patient since they have already been paid by the patient.  That adds to the delay of reimbursement to the patient by the state.  Figure on a one year wait for reimbursement to be on the safe side.

xb wrote on February 16, 2013 at 3:02 pm

Actually, I think since most dentists in the area are network providers for Delta Dental, most dentists are forced to wait for the reimbursement.  Delta Dental of IL's website indicates about 50 dentists as network providers within 9 miles of 61820.

Sid Saltfork wrote on February 16, 2013 at 5:02 pm

Try getting them to wait.  You pay.  They send in the paperwork.  You get reimbursed by the dental plan based on what the insurance pays for the procedure which may not be what the dentist charges for the procedure.  My family has been through this before.  Presently, we are waiting for a chunk of money.  It was irritating to find out that one of the professionals was 5 months behind in their completion of patients insurance paperwork.  That adds to the delay.  The employees, and retirees pay a portion of the insurance in their monthly checks along with the deductibles.  It is not "free".  

If you have not realized it by now; the State of Illinois has become a scummy employer.  I would not encourage any young person to work for the State of Illinois based on it's track record of corruption, and disregard for it's employees. 

SaintClarence27 wrote on February 17, 2013 at 3:02 pm

They'll generally wait, but if it's Heartland Dental, expect to be part of fraudulent claims and to be subjected to unnecessary dental work. Any dentist that's part of Heartland Dental should be avoided. Do a google search for Heartland Dental and fraud.