Broker blog from Delta Dental

Author: Delta Dental (Page 1 of 17)

Has COVID-19 changed open enrollment forever?

The COVID-19 pandemic has caused long-lasting changes to our priorities as a society and as individuals. From cancelled events, working from home and separation from friends and family, we’ve had to adapt to the situation as best we can. So, it’s no wonder that the uncertainty of the pandemic has caused enrollees’ priorities to shift.

Enrollment methods have changed

Due to COVID-19, most brokers experienced a change in their most frequently used enrollment method in 2020, according to a survey by BenefitsPRO. Only 2% of enrollees used paper enrollment forms, while 38% of enrollees signed up online, using self-service portals. For 76% of agencies, the way they do business has changed after 2020.

You should also expect that having online open enrollment may mean that your groups will be looking for any data you can share with them. Having hard data about what benefits are being selected, historic price information and other statistics about your current clients will help you gain more clients in the future.

Greater focus on the whole family

In the past year and a half, many adults became caregivers for their parents and took on education roles for their children while also working full-time. Employees are looking for benefits that extend to their family members and benefits that make the care of their family easier, like family and medical leave, assisted living coverage and child care coverage. Getting the whole family covered even extends to furry friends; the number of pets insured in North America has increased 23% since 2019.

Mental health services are more important than ever

The stress and difficulty of the pandemic have taken a toll on mental health. The percentage of adults in the U.S. who reported symptoms of anxiety and depression increased from 36% to 42% between August 2020 and February 2021, according to the Centers for Disease Control and Prevention.

Before the pandemic, Americans only chose virtual options for mental health care 20% of the time. After the pandemic started, the American Psychiatric Association saw their own members’ usage of telehealth services jump to 85%.

Employers are responding by offering mental health benefits that include access to online resources and apps that address stress and difficulty sleeping. About 70% of employers planned to start, continue or expand investment in mental health resources in 2021, according to a survey by McKinsey & Company. Employers who invest in mental health coverage get results. Almost 86% of employees who are treated for depression symptoms show substantial improvement in work performance, according to one study.  

Employees expect to keep using telehealth options

While virtual visits won’t completely replace in-person visits any time soon, they’re definitely sticking around. Telehealth visits spiked during March 2020, but there were 10 times more telehealth visits in March 2021 than in March 2020, according to a market report.

Employees are using telehealth services and, in many cases, they expect to keep using it. In some cases, patients rated their interactions with their providers higher when they had virtual appointments than in-person. To appeal to a variety of employee preferences, Delta Dental offers two different kinds of virtual dentistry: video-based and photo-based.

Virtual events preferred over in-person

With many employees still working from home and continually changing safety recommendations, in-person enrollment events are still being pushed online. Luckily, virtual enrollment has advantages for you and your clients. Instead of fielding phone calls and emails all day, you can update your website in real time to address common questions. Enrollees can research and select benefits without having to keep track of physical papers or even leave the house.

What do successful virtual open enrollment events look like?  A study by Flimp Communications concluded that a high-performing open enrollment campaign includes:

  • Microsites. These websites are customized to fulfill your groups’ specific benefits needs with unique visuals, video and copy and can be used to address members’ frequently asked questions.
  • Video. Both short-form and long-form video have a place in your campaign. A short-form video may simply be a quick, supplemental explainer and a long-form video would be more detailed and available for employees on demand.
  • Links. Linking out to your enrollment portal, to helpful PDFs, contact pages or financial-wellness portals helps employees sign up for and best utilize their benefits.
  • Decision support. Tools that collect all key benefits information into one place and then make recommendations based on algorithms or questionnaires had higher-than-average engagement.
  • Analytics. With real-time analytics, you and your team can adjust to help employees answer questions online. When you know what drives traffic, what people want, and when people want it, you’ll be even better prepared for next time.

The pros and cons of virtual events

Technology has its limits, however. The Pew Research Center found that only 26% of internet users aged 65 years or older felt very confident when using electronics to get things done online. If all your materials are online, make sure they’re easy to find for everyone, regardless of skill with technology. That means clearly labeling links and having logical paths through your website, as well as making sure all materials can be easily downloaded and viewed without special software.

In that same vein, virtual open enrollment gives you the ability to be increasingly accessible to those with disabilities. Gaps in accessibility can leave individuals with visual, hearing and motor disabilities without the ability to make informed decisions about their health care. By using accessible websites, you make it easier for everyone in your clients’ groups to get health care. 

Open enrollment changes motivated by COVID-19 may be here to stay. Adapt your open enrollment offerings to serve your group clients’ needs during and beyond the pandemic. Being flexible and responsive helps ensure members understand their benefits for the year ahead and are able to get the coverage they need.

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, for both dentists and insurance companies, AI technology will bring accuracy, consistency and efficiency 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 clients.

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 clients.

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 clients.

“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 clients. 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.”

Oral health resources for Spanish-speaking members

Language should never be a barrier to receiving proper care. One in seven people in the U.S. speaks Spanish at home, yet Hispanic adults with limited proficiency in English receive about one third less care when it comes to their health.

In taking steps to bridge this gap, Delta Dental offers a variety of language assistance options for both you and your Spanish-speaking clients with a limited proficiency in English. Whether your clients are looking to improve their health from home or in their dentist’s chair, there is a resource just for them.

Resources for brokers

  • Our website, and all its offerings, can be found in Spanish. This includes plan information, wellness articles, videos and even Grin! magazine and is a perfect introduction to Delta Dental for new clients with limited English. You can assist your clients in finding the information they need about their plan by sharing helpful links that have already been translated.
  • Plans are also available for purchase on our website. You can refer easily refer Spanish-speaking customers to this translated page, but don’t forget to share your unique broker number to receive credit!
  • Flyers are a great way to share important information on common issues and conditions. Business clients with Spanish-speaking team members can access many of our monthly wellness materials and benefits resources translated and ready to print on our Employee Resources page. Looking for a document that’s available in English, but not yet in Spanish? Ask your account executive, and our team will be happy to make a translation available.

Resources for members

  • Customer Service is available in Spanish, as well as English. To talk to a representative, members can call 866–530-9675 and dial 8 when prompted. Answers to our most frequently asked questions are also available in Spanish on our website.
  • Interpretation services are also available for in-person dental appointments when a Spanish-speaking staff member isn’t available. To request this service, members should contact Customer Service at least 72 hours in advance of an appointment.
  • The online dentist directory is not only available in Spanish, but it includes information on which practices have Spanish-speaking staff. Members can use the Refine Search tool to find a Spanish-speaking dentist nearby.

Helping your clients find the right dentist to fit their needs has never been easier. Learn more about Delta Dental’s Language Assistance Program and how it can benefit your diverse clientele.

Boost confidence in clients’ choices with DentaQual ratings

Consumers often rely on reviews to help make decisions, but subjective commentary isn’t always the most reliable way to find a health professional. When it comes to rating systems for dental care, patients deserve reputable sources based on facts. That’s where DentaQual comes in.

DentaQual is a ratings system that relies on actual data — rather than opinions — to help your clients navigate their options with ease and give brokers like you confidence in Delta Dental dentists.

How do DentaQual ratings work?

When your Delta Dental clients search the dentist directory, they’ll notice one-to-five-star scores. These DentaQual ratings are based on statistical analysis of claims data and developed by P&R Dental Strategies, a neutral third party and research company with over 20 years of experience.

The reviews are based on:

  • Procedure success rate
  • Commitment to best practices
  • Value
  • Patient retention
  • Treatment recommendations

This fair and unbiased feedback can help your clients feel more confident about choosing a dentist.

P&R Dental Strategies isn’t funded by insurance companies and provides reviews only for dentists with enough data available to make an accurate assessment.

Transparent information for your clients

As of April 2021, Delta Dental PPO™, Delta Dental Premier® and select DeltaCare® USA dentists within our 15 enterprise states and the District of Columbia have DentaQual ratings in their directory listings. Delta Dental’s dentist directory aims to make finding a dentist as easy as possible. Now, along with languages spoken, office hours and other crucial information, members can see DentaQual’s objective evaluations.

Better yet, DentaQual automatically refreshes scores each month, so members can always rely on the accuracy of their dentist’s rating.

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 clients. It drives up the cost of coverage for your clients and their 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 your clients to instruct their 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. Ask clients to let their 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. Encourage clients 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 your clients

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 your clients’ employees can keep in mind as they choose their dentists.

  • 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.
  • 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.
  • Ask dentists if they have written anti-fraud policies and if their office staff has read and signed these policies.

To help clients’ companies avoid fraud, you can also:

  • Refer clients to the “Fight Fraud” flyer (PDF) as an educational aid
  • Encourage clients to implement a clearly defined anti-fraud policy and have employees sign it
  • Encourage clients to 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 clients and encourage them to do the same. Callers may remain anonymous if they choose.

Track your success with our broker rewards dashboard

If you sell our small business plans, here’s a tool that can help you shine! The small business rewards program dashboard for brokers has everything you need to take full advantage of our broker rewards program.

Retention information

Some of the dashboard’s helpful features include:

  • Your rewards program earnings
  • Your bonus level status
  • Targets that show you how many new sales you need to reach the next bonus level
  • New sales and persistency bonus status summaries
  • Active groups retention counts
  • Total groups year-to-date, including new and existing groups
  • A downloadable report
  • Rewards program eligibility rules and requirements
New sales information

And if you need support, it’s available via email or phone at 866–760-4080.

To take advantage of all the dashboard has to offer, register today. The process is simple. All you need to get started is a few pieces of information:

  • Your name
  • Agency name
  • Email address
  • Social Security or individual taxpayer identification number

After you’ve entered the required information and we’ve located your broker account, we’ll send you a validation email to complete your registration. Note that you may not be able to access the dashboard directly if your agency is the legal entity receiving commissions rather than you.

For questions about the dashboard or the broker rewards program, please contact your Delta Dental sales account executive. Interested in selling to small business? Learn more about our Small Business Program.

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