There are a lot of new norms in the changed world of COVID-19 today. Have you gone to see your dentist lately?
Another New World
Things are not the same. While it all affects you, what you and many others might notice most notably will be the cost. Pre Covid-19, different levels of care required different levels of safety precautions. The infection control procedures before Covid-19 are obviously going to be different from the infection control procedures of today. Dentists across the country are tacking on surcharge fees to the cost of each and every appointment. In addition to the skyrocketed cost and short supply of Personal Protect Equipment (PPE), dental offices may also have had to buy additional equipment to combat the new safety concerns of Covid-19. These costs have added up, and dental practices have had to figure out creative ways to help share the costs.
Dental Protection, Extra Procedures, Equipment & Costs
Just think about what happens while you are in that dental chair. AEROSOL CONTAMINATION should be the first word that comes to mind! In addition to the need for the staff to don extensive PPE for your visit, dental procedures, including hygiene visits and operative dental procedures may require additional buffer times between appointments. That time will be well spent on decontamination and sterilization. That may mean more staff, decrease quantity of patients, and expensive, mounting costs to operate financially solvent dental practices.
The Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC) have released extensive directives for PPE as well as specialized clothing for the protection of those dental care workers exposed to these same aerosol sprays and saliva during dental procedures. This is for appropriate protection against infection materials. The equipment is required to create a barrier between the dental clinician and pathogens that may be present during dental procedures. Each and every practice is required to remain in compliance with OSHA standards for blood borne pathogens, respiratory protection, and PPE.
Just look at this list of PPE and equipment many practices have had to add to their practices:
Air purifiers/circulation equipment
Upgraded ventilation
Air-suction devices
Room filters
K95/KN95 respirators
High-grade surgical masks
Gowns & face shields
Goggles
HEPA Filters
Dental practices are charged with decontaminating patient treatment areas and providing each with physical barriers or partitions between treatment areas.
Not only have guidelines been issued on how to don the equipment – the removal and disposal of PPE is of utmost importance and needs to be aligned with infection control contamination procedures.
Additionally, dental practices may have had (depending on the treatment plan) to discontinue the use of ultrasonic scalers, air-water syringes, and air turbine hand pieces and prioritize the use of invasive techniques by using hand instruments only. This is to minimize contamination as the presence of some virus strains can last for as long as twenty-nine days according to published literature (Barzon et al., 2016).
What Does All of This Cost?
A lot. Your share is primarily up to your dentist – but you do have some control here. The key, of course, following our never-ending HealthLink Advocates mantra - staying in-network! The American Dental Association has not established a fee schedule for the additional charges. Every dentist individually determines whether or what to charge for these changes.
The American Dental Association has recommended billing procedures to cover the financial costs for dental practices up against all of these additional costs. Dental offices are guided to use CDT code D1999 (Unspecified Preventive Procedure) in their billing as an interim solution to recoup costs.
HealthLink Advocates has heard from more than one dental patient on this surcharge. The opinions seemed to be heated. Some understanding. Some outraged. Common amounts have ranged from $15.00 to $30.00. The first question always is, “Am I responsible for this charge?” The answer depends….
If you are fortunate enough (or smart enough!) to have an in-network dentist – you will most probably not be responsible for any of the surcharge. It will all depend on the agreement/contract your insurance carrier may have with your dental provider. Below find some individual insurance companies coverage policies (as per the American Dental Association as published in July 2020):
BlueCross Blue Shield - Appointments 6/1/20 - 8/31/20 – reimbursed $7 per claim
Humana - Appointments 6/1 – 9/30/20 – reimbursed $7 per claim
Anthem - Appointments 6/15 – 8/31/20 – reimbursed $10 per patient
Cigna - Appointments 6/15 – 7/31/20 – reimbursed $8 per claim
United Healthcare - Reimbursement varies between each plan/dates unspecified
Delta Dental - On average $10, but does vary between states/dates unspecified
These are the costs that the individual providers will charge insurance companies utilizing the D1999 code. Healthlink Advocates has been following the changes and we are happy to see, thus far, that every month has been extended to accommodate the pandemic. Hopefully, that will continue.
However, if you are in-network, in most circumstances this is not your concern. Even if the dental practice tacks on a cost of $30.00 for the PPE, if you are in-network, payment is dependent upon the contract signed between the insurance company and dental practice. In most cases, charging you anything above the approved amount would essentially be labeled “balance billing” (illegal in most states). On the other hand, if you are out-of-network the dental provider can charge you their full surcharge – but per the American Dental Association, only up to that fee and no more.
When you call to make your appointment, ask if there will be a PPE surcharge added to you bill. Then note:
If you are in-network, ask if the surcharge is covered fully under the terms of your contract – if the answer is “no”, call your insurance company and follow-up on that.
If you are out-of-network, ask if there is a PPE surcharge for in-network patients and how much that cost is. According to the American Dental Association, “It is unethical to only charge uninsured patients or only seek reimbursement for insured patients to address the costs of PPE”. Now is not the time to be shy – ask them to waive or discount the fee for you.
For a family of five, uninsured with a PPE surcharge fee of $30.00 each could ring up costs well over $100.00. This is a time to be your own advocate! It never hurts to ask!