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Delta Dental / changing ada codes to pay minimum benefits

1 FL, United States Review updated:

Our office has been billing delta dental for a long time and the past 2 years have been a little trying. When our office bills out for full comprehensive orthodontic treatment on adolescent patients d8080 delta dental will change the ada code to d8070 (phase I ortho code of transitional dentition) in order to pay out a lessor benefit amount. I usually catch it when I am missing payments and it isnt paying out the full estimated benefit based on the patients treatment fee and lifetime maximum. I have fought with them several times on several patients to the point of parents getting the insurance commissioner involved and I have contacted the ada and the aao to verify what I know is right... It is illegal for insurance companies to change ada codes from what you billed them. They are trying to say they are basing it on the childs age! Which is irrelevent to the type of treatment a patient receives, children are not a robots each child is different and are at different stages of dental development which the orthdontist or doctor knows, not an insurance company looking at an age and an ada code to determine this. I want to complain to someone who can hold an insurance companies accountable from a professional/ dental office. Is there such an agency because I believe we are not considered the consumer?

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  • Fa
      17th of Jun, 2009
    0 Votes

    Contact the ADA and send a cc of the letter to your state's insurance regulatory agency/commissioner as well as your state's federal representatives (congressmen/senators).

    Keep a copy of all your correspondence and document all conversations (dates, times & who you spoke with).

    Any correspondence you send, keep a copy of it - and send it all return receipt so you'll have PROOF that it was received. Talk to the orthodontists or practice managers to see if they have an attorney who can take this up if your practice is being defrauded.

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