Dental Insurance Resources

Third Party Payer Complaints

Are you experiencing problems with third-party payers? Please contact Halie Payne, Director of Professional Affairs (email or 800-688-1907, Ext 103). She will contact you for further assistance. You may also fill out this complaint form with the Missouri Department of Insurance. 

In addition to taking your calls and assisting with day-to-day issues, the MDA advocates for you at the Capitol to help ease the burdens created by dental insurance issues. Learn more about MDA advocacy. 

ADA Resources

Dental Insurance Hub: Find on-demand webinars, helpful articles and downloadable guides for common dental insurance issues including assistance with provider contracts, dental benefits questions, Bento in-office plans, the ADA credentialing service, and CDT resources. 

Third Party Payer Concierge: Do you have a dental insurance question or concern? The ADA Third Party Payer Concierge is a free service for ADA members. Email or call 800-621-8099, weekdays from 8:30am to 5pm.

Contract Analysis Service

It’s important to understand provider contracts so you can decide if they’re best for you and your patients, as well as to avoid unpleasant surprises in the future. The ADA’s free contract analysis service helps you analyze contract terms for a variety of contract types, including dental provider contracts with third-party payers and certain dental management service organization contracts. Learn more below and review the ADA document What Every Dentist Should Know Before Signing a Dental Provider Contract.

Have a Contract Analyzed

The ADA Contract Analysis Service (CAS) was developed based on the common-sense premise that one should always read and understand an agreement before signing it.

This is where CAS comes in handy to educate members, in clear language, on issues concerning contract provisions—thus helping dentists make informed decisions about participating in provider contracts offered. Understanding the contractual relationship before signing helps prevent dentists from later being blindsided by contract provisions. CAS highlights areas that a dentist may wish to request further clarification from the company. Such as:

  • Does the provider agreement limit how much the dentist can charge an insured patient for non-covered services?
  • Or, what type of decisions may result from the company's utilization review programs?
  • How does the contract define the dentist's "Usual" and "Customary" fee?
  • Or, what is the dentist's obligation to his or her patients after the agreement with the dental benefit company is terminated?

Additionally, CAS provides analysis of contracts that offer dental school students scholarships or loans in exchange for a commitment for future employment, and reviews dental management service organization (DMSO) agreements which involve the purchase of a practice.

To Have a Contract Analyzed

  • Scan and email (or fax to 573-635-0764) the contract you desire to be analyzed to the MDA, Attention Halie Payne, Contract Analysis Service.
  • The MDA will then contact you for additional details if needed, will forward the contract to the ADA and will send the ADA analysis to you once completed.
  • CAS is available at no charge to members who request a review through the MDA. Dentists contacting the ADA direct are charged a $50 fee.

Disclaimer

It is important to understand that CAS does not provide legal advice. Whether each member elects to accept or negotiate the provision, of course, is a business decision that must be made unilaterally by the dentist, in consultation with his or her personal advisors. The ADA encourages members to work with their own attorneys and financial advisors for analysis, advice and guidance. Entry into an agreement has legal consequences, and nothing substitutes for the legal counsel and guidance of your own attorney. However, members are encouraged to take advantage of the ADA CAS, especially as the Health Care Reform legislation, and its implementation, unfolds.