Benefits administrator blog from Delta Dental

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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.

The new normal: hybrid workplaces

Over a year after non-essential workers quickly adapted to operating from home, a survey by PwC found that nearly 70% of executives believe that employees should return to the office three days a week while just 20% of employees agreed with that sentiment. In fact, that survey also found that 30% of employees would stay remote a full five days a week if allowed. Additionally, the New York Times found that just 25% of workers would prefer to go back to an office full-time. As COVID-19 restrictions continue to be lifted, the compromise for many offices has been hybrid work models. These models not only accommodate workers both remote and in the office as a means of safety, but have also become staples of employee satisfaction.

“Compromise,” however, is the key word. As hybrid work is new to much of today’s workforce, a learning curve is to be anticipated. Here’s what you need to know about the future of hybrid workplaces.

Why go hybrid?

In a post-pandemic world, only one thing is for certain: there is no “back to normal.” Many everyday practices have evolved to accommodate new health and safety protocols, including day-to-day office life. In a hybrid model, social distancing is made easier by having less people in the office, thereby minimizing the chance of a virus running rampant.

Going hybrid may also help companies save budget otherwise spent on office space. As of January 2021, demand for office leasing was down 61% from December 2019, according to Business Wire. As some businesses opt to let go of their leases, they might also choose to stagger in-office and work from home days for some teams to accommodate staff while maintaining less space.

While some companies may fear that this newfound flexibility could hurt productivity, research shows that it is simply not the case. A 2020 report by Microsoft found that 82% of the leaders they’d surveyed found their teams to be at least as productive working in their new remote environments as they had been in an office.

In addition to flexibility, other advantages include:

Disadvantages of remote work

As many workers have now experienced, not every aspect of remote working is a positive. While the hybrid model might help remedy some of the disadvantages, there are still some concerns:

  • Burnout. Perhaps you’ve heard of, or even experienced, “Zoom fatigue” — the physical and mental exhaustion brought on by too many video conferences. Screen burnout is very real. In a hybrid work culture, time spent with your team truly face-to-face may help relieve that draining feeling associated with spending hours meeting virtually.
  • Company culture. One disadvantage of working from home cited repeatedly through the pandemic was the feeling that company culture and values are harder to upkeep virtually. Bringing workers back to the office a few times a week may help create physical reminders of the company mission.
  • Reliance on technology. Technology is not infallible. There are internet outages, security risks and keyboards accidentally taken out with a spilled water bottle. When a single laptop is your only means to get the job done, there’s a lot riding on a little piece of technology.

Considerations for employers

With so much uncertainty about what the next year holds, flexibility and adaptability in the workplace is an important consideration for all employers. According to the Society for Human Resources Management, these are a few of the questions that company leaders should ask themselves when considering a hybrid workplace:

  • Why does a specific employee need to perform his or her work in the office?
  • To what extent does an employee need to collaborate with others?
  • How is someone feeling about working from home versus in the office?
  • Is that person feeling disconnected or overwhelmed?
  • Is the employee clear about the organization’s strategy and his or her role and responsibilities?
  • What types of meetings are best to hold in person?

Perhaps the largest lesson for employers from all of this is that employee safety should always be at the forefront. Whether employees spend their days at home or in the office, keeping them viable, healthy and happy is a victory in and of itself.

How to support your Asian American and Pacific Islander employees

May is Asian American and Pacific Islander (AAPI) Heritage Month, and it’s a great time to celebrate and honor your AAPI employees. In addition to fun and festivities at work, one way to help your employees feel seen and heard is to offer them quality benefits that fit their needs. Fortunately, there are some simple ways to let your AAPI employees know you have their back.

What hurdles do AAPI populations face when accessing dental care?

In general, racial and ethnic minorities can face extra difficulties when it comes to accessing oral health care in the United States. When it comes to AAPI populations, individuals’ time spent in the United States is the strongest predictor of whether or not they’ve recently visited the dentist. Native-born and long-time residents are more likely to visit the dentist than recent immigrants for three reasons:

  • They’ve likely had more experience with the U.S. health care system. Outside the U.S., dental and medical are often both covered through the same insurance system and may even be available within a single medical center. New immigrants face a learning curve navigating the U.S. system.
  • They’re likely more comfortable communicating in English. Language barriers can make it difficult to find dental insurance, understand coverage and communicate with a dentist.
  • They’re likely wealthier than recent immigrants, so they have an easier time accessing and affording care. Wealth increases for immigrants of all races as the time they spend in the U.S. increases.

These may seem like issues that can only be solved by time, but dental insurance can help to address them. Dental insurance:

  • Assists employees in understanding the care they need by making diagnostic and preventive care available at no cost or low-cost
  • Reduces employees’ out-of-pocket costs with contracted rates at in-network dentists and cost sharing
  • Helps to bridge language and experience gaps with written material in multiple languages and in-person interpretation

How can I support my AAPI employees?

When it comes to supporting AAPI employees, actions are more important than words. Offer resources that help them get the care they need and alert them to the existence of these resources. If employees are unfamiliar with insurance or dental care systems, they may not know what they need!

If you have a large population of AAPI employees with limited English proficiency, consider providing materials (such as benefits highlight sheets) in their native languages to help them understand their coverage. Delta Dental can provide translations of these essential documents for you to distribute. Just talk to your account manager.

What resources does Delta Dental offer to its AAPI members?

Language barriers can be a major impediment to effectively communicating with a dentist and getting needed care. Approximately 77% of AAPI families speak non-English languages at home. The most common AAPI languages in the United States are:

  • Chinese
  • Tagalog
  • Vietnamese
  • Korean
  • Hindi and Urdu

Delta Dental offers resources and tools to all of its members that may be especially useful to your AAPI employees and their families, including:

  • The Language Assistance Program (LAP). The LAP is a free service that employees can use to get professional interpretive services for their non-English needs. This includes phone assistance, written materials and more, including an in-person interpreter when given 72 hours’ notice.
  • The Find a Dentist tool. Employees can use Delta Dental’s online directory to locate dentists who fit their specific needs. They can search by distance and specialty or search by languages spoken (such as Chinese or Tagalog) and accessibility features.

May is AAPI Heritage Month, but there’s no bad time for considering your employee’s dental care needs. Offering quality benefits like dental insurance is a great way to support the health of your AAPI employees, their families and everyone else on your staff, too.

Employer considerations for COVID-19 vaccines

The speed and efficacy with which COVID-19 vaccines have been developed is a testament to human ingenuity and the drive to create a safer world for us all. The three vaccines that are widely available in the U.S. (Moderna, Pfizer and Johnson & Johnson) have all received emergency authorization by the FDA after demonstrating both efficacy and safety, but there are still some points you may want to consider when deciding on how your company should approach a vaccine policy.

What are my options as an employer?

There are three main courses of action you could take when it comes to employees and vaccines:

  • Do nothing. This means choosing not to implement a company-wide vaccine policy and not advocating for and encouraging vaccinations. Doing nothing may not be the optimal choice from a public health perspective, but it’s certainly a valid one from a legal standpoint. Mandating or incentivizing vaccination could help to reduce increased costs or absenteeism from employees, but it can also expose your company to legal liability depending on how such policies are implemented (and how litigious employees are).
  • Encourage and incentivize vaccination. This is a gentler approach than outright mandating vaccinations as a condition of continued employment. Encouraging employees to get vaccinated is legally safe, although it may run the risk of upsetting employees who don’t believe in vaccination, who have concerns about vaccine safety, who have health considerations that keep them from getting vaccinated or who simply don’t like feeling pressured when it comes to managing their health. Incentives, such as offering paid time off or a bonus to employees who get vaccinated, must be carefully implemented, however. Aside from the cost considerations that comes with bonuses and incentives, you may find yourself legally liable for any issues that arise if you implement on-site vaccinations.
  • Mandate vaccination. This is an aggressive option, but it’s certainly the most effective from the point of prioritizing the health and safety of employees. Mandating that employees get vaccinated is generally legal (although it may not be in some states), but it’s possible that some implementations of such a policy could put you at legal risk (for example, setting up on-site vaccinations or inquiring about employees’ personal health to determine their eligibility for vaccination).

Which employees should get vaccinated first?

Until vaccines become more widely available, it’s best to prioritize employees who are most vulnerable to exposure and at greatest risk of complications from COVID-19. Of course, in health care and senior care industries, everyone with regular contact with the ill and elderly should be vaccinated. Outside of these industries, consider prioritizing:

  • Employees who work in close physical contact
  • Employees who have regular exposure to customers and other members of the public
  • Employees who have regular exposure to heavily trafficked enclosed spaces, food products or other settings where infection may be a risk
  • Employees who are 65 or older
  • Employees who are 16–65 with underlying medical conditions that increase the risk of life-threatening COVID-19 complications

What are the risks of implementing a vaccine policy?

You could get into legal trouble if pre-screening vaccination questions aren’t job-related and consistent with the requirements of your business. To avoid this outcome, make sure that any pre-screening questions are related to the job and that you can prove that unvaccinated employees pose a direct threat to the health and safety of other employees. Similarly, you could get into legal trouble if you attempt to prevent workers’ concerted activity, such as expressing opposition to mandatory vaccines.

Make sure to follow state and local laws, as well. Some locales may have prohibitions against mandating vaccines that aren’t required by state or federal law.

Setting a policy and moving forward

Before settling on the policy that’s best for your company and your employees, there are a few final things to consider.

  • Make sure you follow all federal, state and local laws. You don’t want to put your organization at risk of legal exposure. Do some research to make sure you stay up-to-date on the latest laws and regulations.
  • Get a sense of how employees feel. If you have employees who feel very strongly about vaccines, either adopting a mandatory policy or doing nothing may cause disquiet. Taking surveys of employee sentiments can be a good way to decide how to craft your message.
  • Identify who should be doing the communication. Figures like respected managers, team leaders and union officials can be excellent ambassadors for your company’s policies, especially in larger organizations where employees may not have personal relationships with upper management.
  • Be transparent. As always, communication is key when it comes to rolling out new policies that can affect employees’ work lives. Let employees know both what your COVID-19 vaccine policy is and how that position was reached. Be sure to listen to and address employee concerns, even if your policy remains firm.

Regardless of what policy you decide to implement, wearing masks and respecting social distancing will stay important aspects of infection management. Even as vaccines become more readily available, maintain practices and procedures to minimize the chance of infection and help your entire organization stay healthy.

Common questions employees may have about the COVID-19 vaccine

As the COVID-19 vaccine is becoming more accessible throughout the country, you may find that employees are talking about it and asking questions. Unfortunately, there’s a lot of conflicting and inaccurate information being spread through various media channels. Staying on top of the truth can be a full-time job, but here’s a list of common questions and some points you can bring up in case you hear concerns about the vaccine.

Is the vaccine safe?

Yes. Multiple expert sources, such as the Mayo Clinic and the Centers for Disease Control and Prevention (CDC), have attested to the vaccines’ safety. There are multiple reasons given why someone might be concerned about the vaccine’s safety, but the most common include:

  • Concerns about catching COVID-19 from a vaccine shot. There is no live virus used in the vaccines, so people who receive them can’t contract COVID-19.
  • Concerns about the vaccine damaging cells’ DNA. mRNA vaccines don’t alter cell DNA. Instead, they teach cells how to make a protein, which generates a response that will help the immune system target identical proteins in the COVID-19 coronavirus.
  • Concerns about the vaccines being developed recklessly or too quickly. The vaccines have been tested on tens of thousands of patients. Pfizer and Moderna have published ingredient lists for their vaccines, and the mRNA technology used to make the vaccines has been in development for over 30 years.

I’ve heard reports of people having aches, chills and other symptoms after getting vaccinated. Is this an issue?

No. Some people who have gotten the vaccine have reported muscle pain, chills and headaches, but that is not unusual for vaccines. These are part of the body’s normal immune response. But those who have had allergic reactions to vaccines in the past (which are due to the ingredients used in the vaccines), should first consult with their health care providers before receiving the COVID-19 vaccine.

Should I still get a vaccine if I’ve had COVID-19 previously?

Yes. It’s not clear if having contracted COVID-19 previously grants long-term resistance and immunity, like having contracted chicken pox does. Even for those who have been infected previously, the CDC still recommends getting vaccinated.

COVID-19 doesn’t seem that deadly. Should I get a vaccine if I’m not in a high-risk category?

Yes. It’s true that as a percentage, most people who contract COVID-19 don’t die from it. Still, there can be serious long-term consequences such as lung, heart or brain damage. And even someone who doesn’t get seriously ill can still spread the disease among others who are more vulnerable. Getting a vaccine helps us protect not just our families and loved ones, but also society as a whole.

Once I’ve been vaccinated, do I still need to wear a mask or socially distance?

Yes. Even if a person has been vaccinated, that doesn’t mean that he or she can’t still spread the virus. It takes at least 10 days for the body to develop antibodies to the virus, and the number of antibodies present only goes up with more time. Additionally, research hasn’t conclusively determined if the vaccines prevent asymptomatic infection and spread (although it is likely that they do). Wearing a mask and socially distancing are also good behaviors to model for those who haven’t been vaccinated yet. By getting vaccinated and following other preventive measures, we can all do our part to end the pandemic sooner!

I’ve heard that the vaccine contains a chip inside that lets the government and corporations track people who get vaccinated. Is this true?

No. Some syringe makers include a microchip within the labels of their products so that health care providers can track the shipping history and origin of doses of vaccine. There is no chip within the vaccine itself.

I heard that the vaccine targets a protein that occurs naturally in pregnant women and can cause fertility issues. Is this true?

No. An amino acid sequence is shared between COVID-19 and a placental protein found in pregnant women, but the sequence is too short to trigger an immune response by itself. COVID-19 vaccines won’t cause fertility issues in women.

4 ways to create a motivating workspace

2‑minute read

Earlier this year, we shared how celebrating your employees can boost happiness and productivity. While showing appreciation for your employees is key, it’s not the only way to inspire your workforce. Designing the right work environment — from paint colors to plants — can also help motivate your employees. Check out our tips below to learn how the right office décor can uplift and encourage your team.

1. Don’t fear color. What color are the walls in your workplace? Are you surrounded by neutral tones or bold color? Research suggests that certain colors can affect a person’s productivity. If you want to spark some creativity in the office, try incorporating the color purple. If a laid-back vibe is what you want to evoke, try adding more blue and green to your surroundings. If you don’t want to saturate your entire workplace in color, consider painting a couple rooms to match the energy you’re after.1

2. Bring the outside in. You know how we just said green is a calming color? This is great news if your workplace has a view — nature is full of it! Try arranging your employees’ desks in a way that maximizes their view of the outdoors. What if your windows look out to a concrete jungle? Create your own lush landscape by decorating the office with plants and hanging artwork inspired by nature.

 3. Let there be (sun)light. While we all know too much sunlight can be harmful, sunlight in moderation can have mood-lifting benefits and may even help your employees stay focused.

“Exposure to sunlight is thought to increase the brain’s release of a hormone called serotonin. Serotonin is associated with boosting mood and helping a person feel calm and focused.” – Healthline Media2  

Keep the blinds open to let as much natural light in as possible. If your workplace lacks natural light, resist the urge to crank up the overhead lights, which can be a nightmare for migraine sufferers. Instead, try providing individual desk lamps so your employees can adjust lighting to meet their own preferences.

4. Live your brand. A great way to get your employees excited about your business is to put it right in front of them. Why not display your mission statement on the wall? What about painting accent walls or providing office supplies in your brand colors? By immersing your employees in your brand, you’re helping them become invested in the business, its goals and its success.

 

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1 http://www.arttherapyblog.com/online/color-psychology-psychologica-effects-of-colors/#.W4Qt5cJry01

2 https://www.healthline.com/health/depression/benefits-sunlight

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