Benefits administrator blog from Delta Dental

Category: Industry and policy (Page 1 of 3)

Find in-depth analysis and the latest news on the dental benefits industry.

The intelligent future of dental insurance

First, let’s set the record straight: Artificial intelligence, or AI, in the dental industry doesn’t mean your dentist will be replaced by a robot. (Although, yes, a robot dentist might be kind of awesome.)

Instead, AI technology will bring the accuracy, consistency and efficiency of the delivery of dental care to a new level. And the good news is that this futuristic technology is here now.

What is artificial intelligence, anyway?

While the technology is complicated, the idea behind it is simple: AI uses computer software to analyze large sets of information and find patterns in them. As it gathers more and more information, it gradually learns to assess situations and then make informed decisions or predict outcomes.

So what does artificial intelligence mean for the dental industry?

When a patient visits the dentist for to receive treatment for a dental issue, two things must occur. First, the dentist must determine the appropriate procedure and submit a claim to the insurance company. Second, the insurance company must determine whether the dentist’s claim is valid and the procedure will be covered.

For both dentists and insurers, inconsistency and disagreements during this process can cause frustration and delays, which can in turn lead to frustration and delays in treatment for your employees.

Here’s how AI can help.

AI can make quick, impartial decisions

In many cases, AI can analyze data far more quickly and accurately than a person can, and can act as a second opinion. One of the most promising applications for AI is analyzing oral imagery, or as they’re more commonly known, x‑rays.

“When dentists make diagnostic decisions, there are clear-cut rules,” said Dr. Daniel Croley, Delta Dental’s chief dental officer. “There are clinical rules that say, ‘This is decay,’ or ‘This is periodontal disease.’ However, that’s also open to some interpretation, and dentists have different levels of aggression when they want to treat disease.”

AI analyzes x‑rays to bring consistency and reliability to decision making, Croley said.

AI can help eliminate fraud

Certainly, most dentists are ethical and want to provide only appropriate treatment for their patients. Still, insurers have to watch out for those few bad actors who abuse the system to help ensure dental care remains safe, effective, available and affordable for your employees.

For questionable claims, insurance companies have teams of dentists available to review claims and the accompanying x‑rays for fraud. But the volume of claims insurers receive (Delta Dental processed more than 34 million claims in 2020), makes manually reviewing every claim for fraud impossible.

AI can help dramatically expand insurers’ ability to detect fraud. By being able to examine and compare thousands of x‑rays, AI can quickly detect abuse such as resubmission fraud, where a dentist uses the same x‑ray to submit multiple claims, and overdiagnosis. (It can also identify honest errors, such as when a dentist mistakenly submits the wrong image.)

Because AI can retain vast amounts of information and compare it instantly, Croley said, it can identify potential fraud much more easily than a person can.

“It will be able to not only to review reports like we do to determine how a certain procedure was done,” Croley said, “but it can also look at the x‑ray that was submitted with it and say, ‘Hey, this was submitted last year for another patient.’ AI will be able to recognize that and learn as it as it goes along.”

It’s for this reason that Croley believes fraud detection is emerging as one of the leading uses for AI in dentistry right now.

This ability to detect fraud quickly and accurately is a win for everyone. It protects insurance companies from dishonest dentists and conversely ensures that ethical dentists are treated fairly by insurers when they submit claims. This trust and efficiency will in turn inspire confidence for your employees.

“We only want to have quality dentists and dentists who deliver quality care in our network,” Croley said. “What AI will help us do is to monitor our network very closely, develop appropriate oversight plans and then take action when necessary. And I think how that manifests for our members is more confidence in the dentists that are endorsed by Delta Dental as network providers.”

The future for AI in dental insurance looks bright

AI is still an emerging and evolving technology, so its full promise hasn’t been realized, and there are still challenges that must be overcome. For instance, many states require a licensed dentist to be involved in any review of a dental claim.

“There’s still a lot of rules around benefit determination at the state level,” Croley said, “but once regulation starts to keep up with the technology, we may see some of that evolve from a regulatory standpoint.”

Still, Croley is optimistic about AI’s potential and what it will mean for your employees. He believes AI will enable Delta Dental to improve the quality of treatment that its dentists deliver and members receive. This in turn will increase members’ confidence in Delta Dental.

“This is what I’m excited about,” Croley said.” People trust us to do the right thing, and AI will enhance the level of trust that they have with us.”

Dental fraud — what it is and how you can help fight it

Fraud accounts for an estimated 3% of the United States’ total spending on health care, according to the National Health Care Anti-Fraud Association. That may sound like a small percentage, but with dental spending in the United States projected to reach almost $200 billion by 2030, that means over $6 billion in dental fraud that year.

Dental fraud is “any crime where an individual receives insurance money for filing a false claim, inflating a claim or billing for services not rendered,” according to the American Dental Association. Fraud can take many forms, but it requires intent, deception and unlawful gain.

Fraud harms your business and your employees. It drives up the cost of coverage for you and your employees in the form of higher premiums. Every year, the average family in the United States spends an extra $400 to $700 on increased premiums because of fraud.

Common signs of fraud to watch out for

Because fraud requires intent and deception, there are signs to watch out for. Encourage employees to check their Explanation of Benefits statements and look out for dental offices that:

  • Submit claims for covered services when non-covered services are provided
  • Recommend unnecessary or expensive services when simple services will suffice (for example, recommending a crown when only a filling is necessary)
  • Report inaccurate treatments to the insurance company (for example, prophylaxis vs. periodontal maintenance)
  • Misrepresent dates of service to the insurance company
  • Fail to disclose insurance coverage to their patients
  • Refer patients to specialists when treatment is not needed

It’s entirely possible for dentists and staff to find themselves on the wrong side of the law after an attempt to help patients who might be seeking help with their coverage. Waiving coinsurance costs is one example of this. In other cases, it might be a simple oversight. Common mistakes considered fraud include:

  • Listing the incorrect treating dentist on a claim
  • Coding the wrong treatment (for example, prophylaxis vs. periodontal maintenance)
  • Altering dates of service

Fraud can also be perpetrated by dentists’ patients. Let employees know that the following actions are considered fraud.

  • Using another person’s ID or multiple IDs to obtain benefits
  • Requesting that dentists misreport dates to circumvent calendar year maximums or limitations
  • Misrepresenting available coverage to dental staff or asking them to misrepresent care to the insurance company (this includes concealing dual coverage)
  • Adding individuals to a policy who are not eligible dependents or family members

Finally, employers can find themselves on the wrong side of fraud law as well. Be sure to avoid:

  • Allowing ineligible people to enroll in coverage
  • Making inaccurate statements that can reduce workers’ compensation premiums. Such statements include misclassifying employees, underreporting employees, underreporting payroll, reporting full employees as independent contractors and misrepresenting the name under which your company does business.

What you can do to help protect yourself and employees

Fraud can happen at any point in the process of providing care, accepting payment and submitting claims. Dental offices with clear, consistently applied policies can help everyone play their part in fighting fraud. Here are some general tips that you can encourage employees to keep in mind as they choose their dentists.

  • Discuss coverage, fees and payment prior to the dentist providing services, especially for optional and non-covered services. This way employees will fully understand what their financial obligations are prior to accepting service.
  • For treatments over $300, request a pre-treatment estimate from dentists. This is a free service available to Delta Dental PPO™ and Delta Dental Premier® members. DeltaCare® USA members should review their benefit booklet for a list of covered services and applicable copayments.
  • Ask dentists if they have written anti-fraud policies and if their office staff has read and signed these policies.

To help your company avoid fraud, you can also:

  • Refer employees to the “Fight Fraud” flyer (PDF) as an educational aid
  • Implement a clearly defined anti-fraud policy and have employees sign it
  • Set up internal controls and segregate duties (for example, ensuring different sets of employees have access to plan assets and records, rather than putting one person in charge of everything)

What Delta Dental does to help prevent fraud

You don’t have to combat fraud on your own. We’re proud to be your partners in working to eliminate fraud at all levels and steps of the dental care process. What we do includes:

  • Educating our clients, members, dentists and employees about fraud detection and prevention
  • Conducting clinical patient examinations to ensure that provided services meet professional standards and were correctly submitted
  • Reviewing financial and treatment records to ensure contracts are followed
  • Reporting potential cases to state and federal law enforcement and cooperate with fraud investigations
  • Pursuing the recovery of funds when fraud is suspected
  • Terminating contracts when fraud is confirmed

If you suspect fraud, report it. Call Delta Dental’s Anti-Fraud Hotline at 800–526-1852. Provide this number to your employees and encourage them to do the same. Callers may remain anonymous if they choose.

Kids’ unmet oral health needs highlighted by the pandemic

When your employees become parents, they receive an onslaught of information about their child’s growth markers and health checkups from immunizations to well-child visits. When it comes to dental care, however, less than half of parents receive professional advice on when to start taking their child to the dentist.

And lack of guidance is only the beginning of the problem. Access to dental care has been an ongoing challenge for U.S. children, but during the pandemic, dental care emerged as children’s greatest unmet health need, according to a recent study published in JADA.

What does this mean for your employees and their children, and what can you do to support them?

The pandemic’s effect on pediatric oral health

Even before the COVID-19 pandemic, dental disease among children was rampant:

The pandemic made these problems worse by stressing the financial systems that delivers dental care with income and job losses. Households were three times more likely to identify dental care as an unmet health need as a result of the pandemic compared to medical care, according to a JADA study. The authors found a significant association between the probability of unmet child dental care and pandemic-related household income or job loss.

About 40% of families reported the loss of a job or decrease in income due to the pandemic. Before the pandemic, children from families with lower income or who were on Medicaid were twice as likely to have cavities than children from higher-income households. Whether due to lost or decreased income, fear of contracting COVID-19 and mixed communication from health organizations, dental care visits dropped in 2020.

Many people were able to stay covered for medical procedures due to robust signups for Medicare and Medicaid pandemic. But cost remains the major barrier to receiving dental care, since Medicare and Medicaid packages rarely cover many dental procedures. Although access to pediatric dental care has grown for families with public insurance since the early 2000s, kids in low-income families are still less likely to visit the dentist regularly. Additional barriers include difficulty finding a willing dentist, transportation and geographic proximity to dental providers.

Potential solutions for children’s unmet oral health needs

As a benefit administrator, you can invest time into communication efforts that may bridge knowledge gaps among your employees. Here are a couple of ways you can get started:

  • Talk about timelines. Inform your employees about recommended timelines for pediatric care to guarantee they get the information they need, whether or not their dentists communicate that information.
  • Design your package. When you’re designing your benefits package, cover important preventive services for kids, like sealants and fluoride treatments.
  • Highlight plan features. Encourage employees to take advantage of aspects of their insurance, like teledentistry coverage, that can make pediatric care easier. Did you know that 75% of pediatric dentists offer virtual services, compared to only a third of general dentists?
  • Share materials. Explore Delta Dental’s wellness resources and share a selection of helpful articles and flyers in an email or on an internal site. You can even highlight assets that are made for kids, like MySmileKids and Grin! for Kids.
  • Be consistent. When communicating helpful information to your employees, using multiple channels can be confusing and difficult to keep track of. Find a simple routine for sharing, like posting information on an internal webpage with monthly or quarterly email notifications, so that your employees always know where to look.

How Delta Dental invests in communities

To help dentists make investments in their communities, the Delta Dental Community Care Foundation awards several million dollars in grants each year to increase access to care. These awards enable underserved individuals, including children, to get preventive and restorative treatments in accessible locations. More than 250 organizations received funding from the Delta Dental Community Care Foundation during the COVID-19 pandemic, totaling $11 million to provide relief. Many of these clinics support and serve children.

These Access to Care grants fund activities designed to remove barriers to seeking care such as distance, cost, and even fear. The grants can be used to set up mobile or pop-up clinics in a local community, provide dental care in underserved clinical settings, fund outreach programs or offset costs for clinics that routinely provide care to underserved populations.

What comes next

There will probably be some relief for underserved communities, including children, soon. The U.S. economy seems to be recovering. The national unemployment rate is projected to fall to 5.3% by the end of the year.

But the problems highlighted by the pandemic shouldn’t be ignored. As a benefits administrator, you can’t be expected to fix all of the problems in the American economy or health care industry. Still, by highlighting resources and keeping your employees informed, you can positively affect the employees you work with and their children.

How the stress of the pandemic could be affecting your employees’ dental health

For many, 2020 ushered in feelings of isolation and fear, as well as new concerns about financial stability, safety, family and how to juggle all of it from home. For some dentists, the stress of the situation has become apparent in their patients’ oral health. Chances are, it could be affecting your employees, as well.

As of March, over 70% of dentists surveyed by the American Dental Association (ADA) Healthy Policy Institute reported an increase in patients experiencing teeth grinding and clenching since before the pandemic. That number is up nearly 10% from fall of 2020. In fact, more than 80% of Americans have reported emotions associated with prolonged stress, according to a January study by the American Psychological Association (APA).

“Generally, manifestations of stress go away when the stressing event goes away. That’s where the pandemic comes in,” said Dr. Daniel Croley, DMD, chief dental officer for Delta Dental. “One of the ways that some people manifest stress is by clenching and grinding their teeth.”

But dental conditions related to stress go beyond just teeth grinding.

Stress-related conditions

Multiple studies have shown that emotions can play a significant role in periodontal (gum) disease. Thanks to an increase in inflammation from stress-induced conditions, the gums can become a hotbed for bacteria, leading to gingivitis. According to the ADA, dentists reported recent upticks in all of the following conditions:

  • Bruxism (teeth grinding)
  • Chipped teeth
  • Cracked teeth
  • Temporomandibular joint disorder (TMJ) symptoms
  • Cavities
  • Gum disease
  • Dry mouth
  • Bad breath
  • Mouth sores

Delta Dental claim data also suggests a rise in stress-related conditions. Bite guards, commonly associated with treatment for bruxism and TMJ, were prescribed 14.3% more by Delta Dental dentists in the second half of 2020 than during that same period in 2019.

Sleep and ergonomics

During the mad rush to convert homes to offices in the early days of the pandemic, couches and stools took the place of lumbar-supported work chairs. Ergonomic workspaces became less of a priority than merely having a functioning workspace and the resulting poor posture may also be to blame for some TMJ issues. Whether your staff is at home or back in the office, it may be time to brush up on proper ergonomics for their workstation.

Likewise, stress and disrupted routines likely hurt the chances at restorative sleep, increasing nighttime teeth grinding. Insomnia and restlessness can result in bruxism and TMJ. Restful off-hours are critical for productive workdays, so consider sharing resources for mindfulness and healthy nighttime routines with your team.

Mask mouth

On top of these stress-induced issues is yet another pandemic problem: mask mouth. The facemask has been a staple of pandemic life and has greatly contributed to the slowing of the virus but can come with unfortunate byproducts: bad breath, dry mouth and even gingivitis and tooth decay.

Dental professionals attribute mask mouth to dehydration and mouth breathing when wearing a face covering. Though the ADA found no substantial rise in these specific indicators, the symptoms are easy to prevent by brushing thoroughly and drinking enough water. If your staff wears masks throughout their workday, it may be helpful to lay out guidelines for when they can remove them to stay hydrated.

Other reasons for the spike

It is important to note that not all of these conditions are caused solely by anxiety and tension. For instance, a broken tooth could come as the result of anxiety-induced teeth-grinding, but it could also be caused by an accident or prolonged dental problems. Unfortunately, most claim data does not include the cause behind the diagnosis. Without that, it is impossible to say with absolute certainty that stress is the sole reason for a spike in numbers.

“It’s logical to conclude that current stress is leading to those broken and chipped teeth,” Dr. Croley said. “We will monitor and see. As we see broader distribution of the COVID vaccine and our daily lives feel more typical of what we experienced pre-pandemic, we will see our stress subside and as a result the need for bite guards to treat grinding and clenching subside — but our bodies can take some time to re-acclimate. Going back to the typical is still a change from what has been our weird ‘normal’ over the past year and any change can generate stress.”

Educate your employees about how mental health can affect their oral health when signs of stress are detected. Sharing resources on recognizing and managing stress is a great way of letting your staff know that you’re empathetic to their situation and care about their health.

How COVID-19 is changing benefits in 2021

The global pandemic has had a profound impact on the way corporations attract, develop and maintain their human capital, and this includes changes to benefits packages. A June 2020 survey by Mercer found that some of the most common benefits changes that companies were considering in response to the pandemic included:

  • Expanding virtual health and telemedicine programs
  • Enhancing mental health support (including employee assistance programs)
  • Adding or expanding voluntary benefits

Have those predictions panned out? The International Foundation of Employee Benefit Plans (IFEBP) conducted a survey of U.S. employers to determine how the way businesses think about offering benefits has changed because of COVID-19. This study has found a move towards telemedicine, mental health benefits, flexibility around leave and greater consideration given to cost-saving measures. 

Fewer in-office visits means more telemedicine coverage

From visiting the dentist to an unexpected trip to the emergency room, in-office visits of all kinds are down from 2019 rates. That doesn’t mean that people are necessarily receiving less care, though. According to the IFEBP survey, nearly nine out of 10 employers reported seeing an increase in the number of telehealth claims filed in 2020. Dental offices are safe to visit, but for employees who are trying to socially distance (or simply have difficulty fitting a trip to the dentist into their schedule), Delta Dental offers multiple virtual dentistry solutions.

Stress and isolation lead to a greater emphasis on mental health benefits

Mental health claims saw a sharp rise in 2020. As employees cope with the stress and isolation that living with the realities of COVID-19 can cause, adding or enhancing access to mental health care is a cost-saving move. The effects of stress, depression and anxiety may not be as visible as with other issues, but they are no less real. They can lead to missed work and physical health issues, and so they’re equally important to cover with mental health benefits or employee assistance programs that offer support to employees.

More flexibility in leave is required as life throws curveballs at everyone

It’s important to be compassionate and flexible when it comes to your employees’ physical and emotional needs. Parents and other caregivers have been hit disproportionately hard by the pandemic and may need additional support as they try to juggle their work and home lives. Emergency leave for child or elder care, flexible use of paid and unpaid leave and offering carryover options for workers who can’t use their current vacation days are becoming more common.

Voluntary plans are becoming more popular to help keep costs low

Finally, consider that it may be in your organization’s best interests to change the kind of benefits offered. Voluntary plans are a great way to ensure that those who want dental coverage can keep it, even if cost-saving measures become necessary. The Smile On program is also available to provide dental coverage to those who are transitioning out of the workforce.

Communication is key

No matter how your benefits may change in response to the pandemic, being transparent and honest with your employees is essential. By alerting employees to benefits changes, you can ensure that they won’t be caught by an unpleasant surprise. Additionally, letting your employees know when new benefits are available and how to make the most of them can help keep them happier and healthier.

Remote work and employers: what are the pros and cons?

In 2020, we all learned just how fast the world could adapt to new measures. In the workforce, this has meant relying on coworkers and employees to bring their work home without missing a beat. With a year passed since COVID-19 changed the world, it’s time to reflect on the first year as full-time remote employers, what has been learned from it, and how to continue to adapt moving forward.

Here’s a closer look at the pros and cons of remote working:

Pros

Flexibility

Working from home is far from a new concept. In fact, it’s often touted as a job perk by hiring managers. For employees, it often comes down to flexibility. Working remotely can be an opportunity schedule quick errands, focus in a less distracting environment or even to enjoy more time with the pets while still accomplishing the tasks at hand. The freedoms of remote work can be a major morale-booster. A study by PwC recently found that 55% of would like still to keep working from home at least three days a week once it’s safe to return to the office.

Lack of commute

Who wouldn’t choose walking to their living room over an hour commute on an over-stuffed train? Eliminating this often stressful part of the day saves time, money and headaches. It also takes more cars off the road, meaning less air pollution. In November, NASA announced that global nitrogen dioxide concentrations had been reduced by nearly 20% since February of 2020.

Larger pool of candidates

Eliminating a tough commute can also mean a more competitive job market. When people can work from anywhere, it widens the pool of potential candidates. For permanently remote jobs where location isn’t a requirement, employers can reap the benefits with a larger number of viable applicants.

Saved money

Less people in an office means a smaller office space, fewer everyday office expenses like supplies and cleanup, and less utilities at work. These kinds of savings aren’t just beneficial during uncertain times — they can be lucrative to new businesses trying to grow.

Cons

Blurred work/life balance

One of the more complicated issues to arise from remote working has been the stress of balancing a regular workday with our rapidly changing world. When the physical barrier of an office is removed, the lines between professional and personal lives can get a bit fuzzy. While flexible work hours may be a pro, they can become a slippery slope of overtime and burnout if left unchecked. In fact a recent Gallup poll showed that 29% of people who always work from home feel burnt out “very often” or “always.”

Encourage your staff to set up a corner of their home just for work if they can and to stay online for office hours only. Check in regularly to make sure that they feel heard and supported in their work endeavors.

Internet complications

We’ve all heard the horror stories: Someone forgot to mute themselves in a meeting or couldn’t figure out how to turn a Zoom filter off. In 2020, the learning curve got a bit steeper as our toolboxes grew along with our reliance on technology.

A little bit of training and empathy can go a long way in these cases. As expectations change, offer learning guides, webinars and other resources to help employees with the learning process. Additionally, understand that complications can occasionally arise when employees are at the mercy of Wi-Fi, laptops, and other far-from-perfect technologies.

Less organic opportunities for connection

With no watercooler to gather around, those little day-to-day opportunities for staff to connect can be tougher to find. Don’t let it wedge a gap between the team.

Schedule a little time for virtual team-building opportunities, be it a lunch meet-up or a Friday game hour. Take this time to focus on company values and consider how you can foster trust and communication.

As the world continues to change, take some time to reflect on how much you and your team have already adapted and give yourself credit where it’s due. Creating a culture of openness and empathy will help address issues as they arise and keep you connected to your team.

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