Broker blog from Delta Dental

Category: Inside Delta Dental (Page 2 of 3)

Get to know the people behind the scenes at Delta Dental.

Dental consultants: They’re just like us, only cooler

4‑minute read

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.

Are you a benefits decision maker, administrator or HR professional? Subscribe to our business newsletter,  Word of Mouth.

Expert dental claims review? Yeah, we’ve got a dentist for that.

Less than 2‑minute read

Most — if not all — major benefits carriers employ a staff of clinical experts to review claims — so it’s not groundbreaking to say that we have dentists on staff to review claims submissions.

However, would it surprise you to learn that we have nearly 50 people on staff whose names are followed by the initials DDS or DMD? While other carriers also offer consultant claims review, we consider our dental staff an integral part of our value proposition. And because we consider this so important, dental consultant review isn’t subcontracted to an outside agency or delegated to untrained staff.

Using radiographic imaging and detailed treatment descriptions, our dentists determine whether coverage for treatment is approved or in certain cases, denied. In other words, our dentists ensure that benefits are used and applied fairly.

Dr. Joseph Borg, our Director of Dental Policy says, “Our processing policies, backed by our staff of dental consultants, are beneficial to our clients and their employees because they ensure oversight of their benefits dollars — we’re making sure that services are administered and processed appropriately.”

Our dental consultants personally evaluate more than 200 claims per day, ensuring that:

  • Treatment and billing for pre-defined services (e.g., crowns, bridges and periodontal surgery) are appropriate and meet Delta Dental’s stated clinical guidelines.
  • Exceptions to frequencies and/or age limitations are made where appropriate or necessary.
  • Treatment is billed appropriately; for example, a complex service isn’t “unbundled” into a variety of separate codes.

Dr. Thomas Gale, a dental consultant in our Alpharetta, Georgia office, notes, “We want enrollees to get the most from their benefits — the care they expect, the care they require and the care they’re charged for.”


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Plain language policy: Spotlight on Public Affairs

Health care policy can be confusing. Really, really confusing.

That’s why we want to share periodic policy updates and insights with you — in plain terms. No jargon, no nonsense. To kick off our Plain Language Policy series, we’d like you to meet two of our key policy players, Stephanie Berry and Devin McBrayer.

Stephanie Berry and Devin McBrayer headshots

 

Tell us a little about yourself. Your educational background, past work experience, personal accomplishments, etc. 

Stephanie: I have worked at Delta Dental for five and a half years in government relations – primarily handling legislative analysis.

Before coming to Delta, I worked for California Primary Care Association (CPCA) for five years, representing clinics that mostly serve the uninsured and underserved. At CPCA, I was the Assistant Director of Federal Affairs, so I ensured everyone was educated on the Affordable Care Act and what that would mean for them. I really enjoyed doing that.

I started in advocacy and legislation working for Congresswoman Doris Matsui. I worked in her district office, doing a lot of healthcare outreach and that got my feet wet to move toward straight advocacy.

Devin: I also came from Doris Matsui’s office, which is how I met Stephanie. Before that, I worked in D.C. for Congresswoman Lois Capps on the Energy and Commerce Committee. I focused on health policy, assisting with health reform bills and analyzing them before coming to Sacramento.

I have a Master of Public Health (MPH) from George Washington, and being in D.C. was a great experience to see first-hand how legislation is made and how it goes through the regulatory process. So I know how to analyze things here when they come across the table.

Before we’re all work and no play, what do you like to do for fun? What are your hobbies or interests outside of work?

Stephanie: I’m an avid skier; my husband snowboards and the kids ski. Living in Sacramento, we’re close to Sierra Nevadas, so we get to play in the snow, but we don’t have to live in the snow. It’s nice!

Devin: I’m into biking. I live in a super small apartment downtown, but we have four bikes. I also love to hang out with my dog.

Okay, so getting down to business, what is your role at Delta Dental? 

Stephanie: We keep track of new legislation and regulations that affect our enterprise companies. Because our brand is in 15 states plus D.C., that’s where we spend most of our focus. We have lobbyists in each of these states. We write letters of support or opposition and take part in advocacy activities.

We’re also part of the National Association of Dental Plans (NADP) and America’s Health Insurance Plans (AHIP), which help us advocate on the issues happening in states where we don’t have as much presence.

In 2017, we tracked 750 bills. More than 5,000 bills come up in our search topics, and we narrow those down to those that might affect us. 150 of the 750 were signed into law; 50 of those affected us.

What is it like having a direct impact on health policy and legislation? 

Stephanie: It’s feeling like you can make a difference. You can work with constituents when working for a congresswoman. You see the impact. In this role at Delta Dental, it’s writing a support or opposition letter and seeing your advice taken into account.

Devin: Stephanie and I both really enjoy politics and the legislative process. It’s a hobby to be involved. Being active in the political process and analyzing legislation and regulations might seem intimidating to some people, but we enjoy digging through them. With our background, sometimes we are lucky in that we intuitively understand the way a bill may have been designed a certain way and why. We just think it’s fun!

It sounds like you get to have fun for a living. What jumps out as making your work worthwhile?

Stephanie: Coming to this job being raised in California, it’s so interesting learning how other states think. I enjoy going to the Capitol in other states and learning that different perspective. The fact that we have people with boots on the ground in all these states is so helpful. I even went to Montana this year, and partnered with Jim Dole (Sales Account Executive). He was so great at explaining how things tick there. I love learning the history. And I was in Atlanta advocating on a bill recently – that perspective keeps things interesting.

Since you’re new to Delta Dental, what are some of your first impressions? What do you like most about your job so far?

Devin: I most enjoy the team I work with; they understand my background. We’re all equally passionate about the work we’re doing and we all want to be as helpful as possible to other business units. My first few months here have really been about becoming a better resource to the rest of the company. So far I like the openness to collaborate and work together.

Part of our purpose as a dental benefits provider is to “enhance lives” — can you cite an example of something you’ve worked on where you truly think we’re achieving that purpose?

Stephanie: There was a piece of legislation enacted in California in 2015 — AB 648. We supported this bill, which was brought forth by consumer groups. It establishes virtual dental homes, which is kind of like telehealth. Dental providers and hygienists can work in low-income areas, schools, Head Start programs, and clinics and are able to do initial screening and send that info to a dentist somewhere else who can view the x‑rays to evaluate. It helps people where they are. We were the only dental plan in California to support this bill and it was signed into law.

This year, we also supported another California bill, SB 379. There was already a law that says all kids in California must see a dentist before first grade. This bill lets dentists host free oral health assessments at schools because many kids who aren’t do the screenings either don’t have insurance or they’re on Medicaid and don’t have time. This bill will make it easier for kids to have this assessment before first grade.

We’d agree that your role is definitely helping in our purpose to enhance lives. 

Let’s end on a fun note. Since you two work with such complex subject matter, how would you describe your job to an eight-year-old child? 

Stephanie: Gosh, okay. I would say that I’m working to make sure more people have the chance to see a dentist and be sure their teeth are clean and free from sugar bugs. I get to meet with a lot of people and talk about really important issues … I get to go around the country trying to make it easier for people to see the dentist. What do you think of that?

Perfect. Okay, and now a different question. If you had to create your own campaign slogan, what would it be?

Devin: I’ll go with my nickname from childhood and it was Devin from Heaven. I like to think that I’m very nice, and I’ve been successful in working in legislative offices because sometimes you have to deal with people who are… not so nice. So my campaign would definitely be centered around that. I’d come in on a cloud, and there would be lots of stars and some fun music!

 

Thanks for taking the time to get to know two members of our Public Affairs team! For more content and industry news, subscribe to our newsletter.

Certified Ethical Hacker: oxymoron or Information Security genius?

We hope you’ve enjoyed reading our internal spotlight series on Delta Dental’s Information Security. (In case you missed any content, check out our article on employee training and compliance and our article with insights from our Director of Information Security.)

Did you ever think you’d be thankful to read the term “hacker”? If not, we may have a new perspective for you. Meet Chad Greiner, Security Engineer III and Certified Ethical Hacker (CEH) in training, and see how he’s going the extra mile to protect your clients’ privacy.

Q: How long have you been with Delta Dental, and what other jobs have you held in your field?

A: I’ve been here for about six years. Before joining this team, I worked for a medical alert device company. I served as the main administrator for their entire IT operation.

Q: You’re training to become a CEH. Are there any other certifications you have or plan to earn?

A: Yes, I’m a Certified Information Systems Security Professional (CISSP). The CISSP seems sort of like a generalized job title, but it’s actually a comprehensive certification. To sit for the exam, you have to have about five years’ worth of work experience, be recommended by a fellow CISSP in good standing and re-certify every three years. The CEH is kind of an extension of the CISSP, except it focuses on strategies to help you think like a criminal — so you’re better armed to prevent a cyberattack.

Q: With that said, do you think the CEH is a controversial certification?

A: We don’t view it as controversial within the security industry. My perspective is that any type of attack is a crime, so in any criminal field, you need to understand the people you’re trying to catch or obstruct to be effective at your job.

Q: That makes sense. How would you respond to criticism that the title “ethical hacker” is an oxymoron?

A: In my mind, intent is what makes an action ethical or unethical. I’m not necessarily learning how to break things; instead, I’m learning how things can be broken to prevent breaches in security from occurring.

Q: What do you think is the most important aspect of your CEH training?

A: Learning about what tools are out there has been extremely important. Early on in my career, there weren’t as many “hacking” opportunities readily available to experienced cybercriminals, let alone the average person. The way technology is evolving has made it easier to access private information — so it’s that much more important to learn every defense against cyberattacks that we can.

Q: Why do you think being a CEH is particularly valuable to an analyst within an organization like Delta Dental?

A: Knowing what to protect against — knowing what avenues people can take in an attack — is critical. It’s really the first and most important step in securing private information. Clients can have confidence in knowing that, with a CEH, we’re able to get into a criminal’s mindset and get a step ahead of them.


Thanks for reading our series on Information Security! Stay tuned for more client news and insights from Delta Dental. 

Information Security by the numbers

Spotlight on our Office of Compliance (OOC) team, and second article in our Information Security series.

We’ve done the math and found that preparation is better than reparation when it comes to securing private information. That’s why we prepare for security compromises as if they are imminent. In fact, we protect your private information in many different ways.

Beyond cutting-edge technology and a team of security analysts, preventing a security breach includes:

  • 1 focused team of compliance and privacy experts
  • 2 models for setting compliance standards — our enterprise code of conduct and federal guidelines
  • 3 mandatory training programs that educate employees and help prevent compliance, privacy and security breaches
  • 4 ways for employees to report potential compliance incidents if they do occur

98157_OOC article

Our compliance expertise adds up, giving you 10 reasons to know your organization’s private information is in good hands with Delta Dental.

And, did you know that one of the most frequent causes of a privacy incident is incorrect enrollee data? You can help safeguard sensitive information by ensuring that enrollee eligibility files are correct and updated with Delta Dental.

For more information on our approach to protecting your organization’s privacy, check out a recent interview with Sitaram Inguva, our director of Information Security.

Why Delta Dental hires Certified Ethical Hackers

(And other things you didn’t know about security)

Have you ever wondered how Delta Dental protects your clients from a data leak or cyberattack? If you have, Sitaram Inguva — our Director of Information Security — has some insight. And some of it may surprise you.

PHI is significantly more valuable on the internet than credit cards

All matters of information security are serious, but PHI is especially attractive because it can be more useful in identify theft. A data breach can also be very expensive. A recent study1 shows that a single compromised health record can cost a company more than $200 in reparation (per enrollee). For these reasons, we use world-class cybersecurity technology to prevent such compromises from happening.

Hackers and malicious software aren’t the only causes of data leaks

Sitaram says, “A data breach can take many forms, the most obvious form being external hacking attempts by cyber criminals. However, they also happen due to technology gaps, human error and a lack of awareness.” Delta Dental deploys best-in-class technologies to protect information, but our most valuable line of defense is employee training and awareness. Apart from data encryption and up-to-date software upgrades and patches, our greatest priority is ensuring that our people are trained on the latest best practices in information security.

Delta Dental has Certified Ethical Hackers on our side

We have a highly talented security team, many of whom have industry-leading certifications, like Certified Ethical Hacker (CEH). They’re trained to detect vulnerabilities in our security and employ their skills to keep our systems and client information safe.


At Delta Dental, there’s a lot that goes into security. Share this information with your clients to give them confidence that their information is in good hands. 

1 2015 Cost of a Data Breach: United States, Ponemon Institute, May 2015

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