Carriers say all the time that they have clinical consultants on staff. It’s not breaking news that we have a staff of dentists who review claims. But have you ever pictured a dental consultant slamming a bass guitar? Probably not.
Meet Dr. Leigh Westee — empathetic dentist, experienced dental consultant and incredibly interesting human.
Whether you met Dr. Westee during her days as a practicing dentist or you run into her now as a dental consultant, a couple of things remain the same. She’s still passionate about helping patients receive exceptional dental care, and she still spends her free time playing bass in a hard rock band.
How long have you been with Delta Dental? What did you do previously?
It will be seven years this April — and I’ve been a dental consultant the whole time. Before working here, I practiced dentistry for 21 years. While I worked in some large practices, I also did mobile dentistry for a while. I would go into nursing homes and set up right in the beauty salon. I felt incredibly useful — both in providing care and good company.
It sounds like you really liked practicing. What made you become a dental consultant?
I was just ready for a change, and so were my joints! I taught a bit at some dental hygiene schools and really liked it, so I wanted another position where I could apply all the knowledge I’d gained in the dental chair, but still help patients. This position ended up being the perfect fit.
So what exactly is it that you do?
Mostly I review complex claims for Delta Dental PPOSM — like numerous visits for the same procedure. I compare claims to x-rays and other medical data, then apply the plan’s policies. I always remember there are people on the other end, so it’s also really important we take the enrollee and provider perspectives into account.
I also evaluate claims if a dentist or enrollee sends in a dispute or grievance. This is where you’ve really got to be a detective. For example, a new crown could be denied because it doesn’t meet a plan’s frequency limitations, but there are situations where we might override that. We may allow a new crown if the current crown broke and a different dentist had to provide a new one. That’s when I would look at all the info that went with the dispute, like x-rays and charts, and make an informed decision.
Any advice for brokers to share with their clients (and their enrollees)?
Receive routine preventive care. Going to the dentist every six months can greatly reduce the chances of running into most of the claims issues I’m reviewing. You wouldn’t neglect your oil change for five years, so why do the same with your body? Keep your mouth maintained and you can help avoid expensive visits in the future.
What are the biggest challenges you face in your work?
Making decisions on claims is not something we take lightly, so there are definitely times where I can’t make a decision on my own. That’s when I rely on my colleagues to share their expertise — two other dental consultants who work on PPO claims sit right next to me. There are also separate consultants who work on DeltaCare® USA claims and an orthodontist for ortho claims.
Speaking of expertise: How do you keep your skills sharp?
Even though we’re not practicing, we still have to maintain a dentist license. I take about 20 credits of continuing education courses every year. Plus, the whole team of dental consultants meets every month to learn about new topics and share insights.
Wow, you guys certainly stay busy! How do you relax outside of work?
I play bass in two hard rock bands. I taught myself how to play by ear — I actually can’t read music. I had to practice for hours every day for months until it started to click, and I still have to practice a lot. Dentists do like to keep their hands busy!
The first band I joined was an all-female KISS Tribute Band. Now I’m in a Cheap Trick tribute band called Dream Police and an 80s hard rock cover band called Iron Mullet. We get really into the costumes and makeup too. We’ve been hired out for rock events just to make appearances in costume.
That’s so cool. Have you ever met any of your rock idols?
I made it a goal to meet my five favorite bass players. It took me about 15 years, but I did it, and even had their signatures tattooed on me. Oh, and I met Alice Cooper.
I’m sure those are great stories … you’ll have to share with me some day. One last question. If you could remix one of your favorite songs like the singing dentist, what would it be? Can you give us a line?
I’d go with a KISS song. How about “I want to brush and floss all night”?
Thanks for rockin’ out with Dr. Westee! Stay tuned for our second dental consultant spotlight later this month, which will highlight dental phobias and ways dentists can ease patients’ fears. And don’t forget to subscribe to Insider Update, our newsletter for benefits brokers, agents and consultants.
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