Obamacare (Affordable Care Act) and Dentistry

ACA, Affordable Care Act dental, Obamacare As I write this post, Americans must have signed up for healthcare insurance through Obamacare (ACA) if they had not yet obtained insurance. Uninsured Americans may be penalized through a “tax” if they do not have healthcare insurance. We write of this because families have the option of obtaining dental insurance through their chosen Obamacare plan. We have already experienced patients with dental coverage apparently through Obamacare. They arrive at our office with the commonly known insurance cards. These cards may clearly show these patients and their families have dental insurance. It all sounds great so far. However, we have found from our experience that this is not great. We are disappointed.

You see, the insurance carriers that provide for Obamacare are commonly known insurance companies that have provided dental insurance through the private sector. We are well-versed and well-experienced with the insurance carrier-private sector relationship. We have a number of software programs that allow us to quickly obtain information on the dental plans as well as on employee eligibility. When we need to call these insurance companies we may need to wait perhaps 20 minutes prior to obtaining an actual person who can help us.  Yes, service can be better, but it is working. However, with the insurance carrier-national government relationship we have through Obamacare, the service has been disappointing.

Thus far our experience has been with Blue Cross Blue Shield of Texas. We have had to wait up to over 90 minutes prior to obtaining information from a live person. After getting the live person, when we identify the insurance card holder and confirm their having dental coverage, the insurance representative may tell us they in fact do NOT have coverage. After insisting to discuss this with their supervisor, on one occasion, the supervisor DID confirm eligibility. However, the supervisor could NOT confirm the details of coverage NOR could the supervisor offer to us the address where we were to send our dental claims. The supervisor indicated they did not have the information yet. So, things are different. Things thus far are worse. We realize this is new; however, these insurance companies have provided for dental insurance for years within the private sector. There is something about working with this national government that creates inefficiencies, to be kind.

We have been advised by our consultants who assist us with private sector insurance that things are so inefficient now with Obamacare dental insurance that they recommend our accepting payments from patients directly and providing patients with printed information they can mail to their insurance carrier. We regret to inform you of this status; however, we are being truthful, honest, and transparent. The dental side of Obamacare from our experience is a mess to work with at this current time. We have no idea of knowing when this will improve.

Further messing up this situation is a grace period of 90 days from which patients can delay paying their premiums because of receiving a tax credit. This prevents payment of benefits to dental offices for services rendered during this time if patients delay paying their premiums. The chairman of the American Dental Association Council on Dental Benefit Programs, Dr. Andrew Vorrasi, admits in the April 7, 2014, issue of the ADA News that “There remain a number of uncertainties”.

For now we must all be patient. For now we must have patients with an Obamacare dental insurance plan to pay in full for services rendered and we will in turn provide all the documentation patients need to file their own claim. Yes, we do have a number of payment options available. It may have to be the patient’s responsibility to find out where to mail the claim because of current inefficiencies. If things change we will let you know. Just as Senator Pelosi indicated, we are finding out what is in the law AFTER it was voted upon and passed. We regret we must be the messengers on the current state of Obamacare dental insurance.

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