Website shows cost of dental services to patients, insurers

A website is available that helps patients and insurance companies estimate how much dental services will cost.

In order to ensure the costs listed on FAIR Health, www.fairhealthconsumer.org, and other similar websites are accurate, the American Dental Association is recommending dentists submit their full fees to insurance companies on dental claim forms, consistent with current ADA policy.

The slogan of FAIR Health is “Bringing Fairness and Transparency to Health Insurance Information.” The nonprofit organization houses a database that helps insurers determine their reimbursement rates for out-of-network charges and provides patients with a clear, unbiased explanation of the reimbursement process, according to the website.

After typing in the zip code and the procedure, a chart gives the CDT code, the estimated charge, estimated reimbursement and out-of-pocket cost. For example, by typing in the Chicago zip code of 60611 and “root canal,” the user is given a number of different choices. If “root canal-front tooth,” is selected, CDT code D3310 appears, an estimated charge is given, and both the reimbursement amount and the out-of-pocket cost are listed.

The ADA, which granted FAIR Health a CDT license in February, wants dentists to be aware the website is out there for their patients to peruse.

FAIR Health was formed in 2009 as a result of an investigation by former New York State Attorney General Andrew Cuomo, who uncovered conflicts of interest in one system that health insurers used, the Ingenix database, to calculate reimbursement for patients who received care from providers outside their plan’s network.

“The investigation uncovered a fraudulent and conflict-of-interest ridden reimbursement system affecting millions of patients and their families and costing Americans hundreds of millions of dollars in unexpected and unjust medical costs,” states a news release by the New York AG’s office.

As part of the collective settlement the attorney general’s office reached with the insurers, FAIR Health received millions of de-identified health care claims that many had used to help them determine their rates and the data continues to be analyzed to maintain its accuracy.

In some circumstances, in addition to submitting the full fee, dentists should alert the payer if the dentist is providing an additional discount to the patient.

“Dentists should always submit full fees to insurance companies on dental claim forms,” said Dr. Phil Eversman, chair of the Dental Benefit Information Service for CDBP. “Dentists should not submit contractually-discounted fees because this could artificially skew the maximum allowable fees determined by carriers based on data submitted by dental offices.”

Submitting fees that insurers offer to contracting providers rather than the dentist’s full fee could also artificially skew the costs posted on websites like FAIR Health, causing consumers to question their dentist’s fees, in light of what other dentists may be charging in the area.

Currently, FAIR Health only provides data for dental services but its website says medical cost information will be arriving in August.

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Kelly Soderlund, ADA News staff