necessity usually occur because of a lack of documentation or, as stated above, because the procedure is not a covered benefit as defined by the contract.

We deny another 1% of the claims because of dental office error—the claim form is not filled out, not filled out completely or improperly coded. These are typically corrected and paid.

Claims review is neither a delay tactic nor red tape. It is a necessary step to prevent fraud, waste and abuse.

Our customers—one of the largest of which is the government through Medicaid, Medicare, and active and retired federal, state and local government employee contracts—demand that we root out fraud, waste and abuse. We scrutinize for such things as claims submitted by dentists without licenses, scaling and root planing and periodontal surgery for children devoid of gum disease, cores on virgin teeth.

Disappointingly, we find such dishonesty regularly.

DELTA DENTAL SELLS DENTAL BENEFIT PLANS

Too many patients and dentists don’t understand how dental benefits plans work. That’s one of the reasons why health plans don’t typically include dental. It’s also why the cost of dental plans is significantly lower than the cost of health insurance (less than 1/10 the cost).

Insurance is defined as "coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril."

However, as with all types of insurance, Delta Dental does not guarantee against all losses. Delta Dental offers dental benefit plans that pay a specific dollar amount for completed procedures up to an annual limit, with specified limitations and exclusions.