Insurance Commons^™

Mda Insurance: Voluntary Benefits Help With Employee Recruitment, Satisfaction, Retention, Craig Start

The Journal of the Michigan Dental Association

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This article discusses how voluntary employee benefits can strengthen recruitment, retention, and employee satisfaction in dental practices. Topics include health insurance, disability coverage, life insurance, critical illness protection, accident insurance, vision plans, and cafeteria plans. The author explains how benefit offerings can improve workplace competitiveness while helping employees manage financial risks and healthcare costs.

Health Insurance Literacy Among College Students At The University Of South Carolina, Emma J. Smith, Lorie Donelle Phd, Rn, Fcan, Robin Dawson

Caroliniana Undergraduate Research Journal

Purpose: This study aims to investigate the health insurance literacy skills of graduate college students and undergraduate college students.

Methods: A cross-sectional research design incorporated a 20-item questionnaire to examine college students’ knowledge of common health insurance terms and definitions, as well as their perceived understanding of health insurance. Descriptive analyses were conducted of participant demographics, health insurance literacy scores were summarized, and common health insurance policies were tested through a readability checker.

Results: The majority of students were between the ages of 18-25 and undergraduate students. More than half of the participants were female, and more …

A Quality Improvement Project To Decrease Medication Prior Authorization Approval Times, Amena Guinn Babers

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Medication prior authorization requirements add to administrative burden, increase labor costs, and delay patient access to treatment in outpatient specialty settings. This bottleneck directly influences nursing workload and economic performance.

Purpose: To evaluate the fiscal and performance significance of implementing an electronic prior authorization (ePA) process, standardized tracking tools, and staff education in a small orthopedic clinic.

Methods: A pre–post quality improvement design was used. Descriptive statistics and inferential analyses (independent‑samples t tests and Mann–Whitney U tests) were conducted to compare time to approval, staff hours worked, satisfaction scores, and medication pickup timeframes.

Results: Significant reductions were observed in …

Mda Insurance: Review Your Health Insurance Plan For 2026 Open Enrollment, Craig Start

The Journal of the Michigan Dental Association

MDA Insurance President Craig Start urges members to review their health insurance ahead of the 2026 open enrollment period. Open enrollment is the annual window to change carriers, elect new plans, or add dependents. Dates vary by plan: the MDA Health Plan runs from October 1–November 15, while Medicare Supplements/Advantage/Medigap Plans run from October 15–December 7. Members must assess anticipated health changes, potential costly prescriptions, and financial comfort with higher deductibles versus higher premiums. MDA Insurance assists members in making informed decisions and acts as the member's agent of record to help resolve claims and issues throughout the year.

Extension For Insurance And Patient Conflict Prevention, Richard Sherman

SFDDA Newsletter

In 1891, G.V. Black presented the idea of “Extension for Prevention.” The concept was to complete a restoration so that the margins and occlusal grooves were treated in such a way as to “prevent” further carious involvement. Hopefully his technique prevented millions of teeth from needing retreatment. However, dealing with humans and sometimes their “lack” of proper oral hygiene habits, new carious lesions do appear on the same teeth in the same or different areas, This article examines the conflict occurring between insurance coverage and the patient when experiencing a new caries on a previously restored tooth.

The New Professional: Demystifying Dental Insurance For The New Professional, Amrita Patel D.D.S.

The Journal of the Michigan Dental Association

This comprehensive guide explains dental insurance complexities for new associates and practice owners. The author distinguishes dental insurance from medical insurance, noting annual benefit caps of $1,000-$2,000 versus unlimited medical coverage. Four main plan types are detailed: PPO plans (most common, flexible), HMO plans (lower costs, network restrictions), Indemnity plans (no network limits, higher costs), and Discount plans (membership programs, not insurance). Key business considerations include in-network versus out-of-network decisions, with in-network providing patient attraction but reduced reimbursements, while out-of-network allows fee control but limits patient base. The article addresses practical challenges including write-offs (difference between standard fees and insurance …

Mda At Your Service: One Way To Free Your Practice From Insurance Plan Restrictions, Rachel Sinacola D.D.S.

The Journal of the Michigan Dental Association

This Q&A-style article provides practical answers to common member questions. Topics include managing in-office dental plans (via Quality Dental Plan), evaluating associate contracts, showcasing MDA membership, handling radiography training course transfers, and understanding patient record retention requirements. The article encourages using MDA-endorsed resources and legal guidance to enhance practice efficiency and compliance.

The Impact Of High Deductible Health Plans On Mental Health Treatment, Kristian D. Dambrino, Laura Gray, R. David Phillippi

DNP Projects

Background and Rationale: High Deductible Health Plans (HDHPs) are designed to reduce overall healthcare spending by shifting more upfront costs to patients to discourage overutilization of care, yet HDHPs often increase financial burden, particularly in outpatient mental health care. Patients covered by HDHPs often face substantial out-of-pocket costs before reaching their deductible. This can lead to potential delays or discontinuation of psychiatric treatment. Financial transparency interventions by the mental health provider may mitigate these barriers through more-informed patient decision-making regarding payment options. This project evaluates the impact of a financial transparency intervention on reducing payment responsibility for HDHP patients in …

January 15, 2025 — Welcome Letter To Members Of The 119th Congress, American Dental Association

Advocacy in Action letters

No abstract provided.

Evaluation Of Financial Risk Protection Provided By Private Health Insurance In Malaysia, Ng Rui Jie

Student Works (2020-2029)

Private health insurance (PHI) has emerged as an alternative health financing option to public health financing, with the goal of achieving and maintaining universal health coverage. Despite its growing prominence, there is ongoing debate about the extent to which PHI contributes to financial risk protection. In Malaysia, the prevalence of PHI coverage has increased due to factors such as an expanding affluent demographic, government encouragement, and challenges in public healthcare delivery. However, there have been very limited studies assessing the financial risk protection provided by PHI in Malaysia, making this a critical gap that this research aims to address. To …

Dentistry And The Law: The Difference Between ‘Non-Covered’ Vs. ‘Disallowed’ Services, Daniel Schulte Jd

The Journal of the Michigan Dental Association

The article clarifies the distinction between "non-covered" and "disallowed" services in dental plan audits. Non-covered services are not included in the patient’s dental plan, often due to plan limitations, while disallowed services are covered but deemed non-payable due to issues like claim deficiencies or lack of documentation. Dentists must review their contracts to understand obligations regarding non-covered services and ensure compliance with HIPAA for patient-paid services. For disallowed services, contesting decisions may be possible depending on the agreement with the dental plan.

Advocacy Spotlight: Understanding The Mda's Role With Dental Insurance Reimbursement Rates, Daniel Miller D.D.S.

The Journal of the Michigan Dental Association

The Michigan Dental Association (MDA) is dedicated to advocating for members and advancing the dental profession. While federal laws prohibit the MDA from negotiating reimbursement rates with dental insurers, it provides significant support through education, advocacy, and resources.

Key initiatives include enhancing transparency in network leasing, endorsing PPO Negotiation Solutions to help practices optimize contracts, and offering educational programs on billing and coding. The MDA also facilitates peer networking and equips dentists with tools to navigate insurance challenges effectively.

Looking ahead, the MDA remains committed to empowering members through advocacy, guiding future dentists on contract literacy, and fostering a resilient …

Hypertension Screening In Dental Settings And The Need To Address Dental Insurance Literacy, Dorothy Nuckols

Journal of Extension

Extension has an active and dynamic health insurance literacy program with certified educators nationwide, but dental insurance literacy is an unmet need. There is an increasing trend of dental practitioners willing to perform basic preventative health measures, particularly hypertension screening. Lack of insurance literacy is a barrier to screening request and follow-up. Participants in our longitudinal study visited their dentists as regularly as they visited their primary health practitioners. This study shows the need for Extension to add dental insurance literacy to the menu of health insurance literacy programs to impact the prevalence of hypertension.

Nys Workers' Compensation & No-Fault Cases: The Good, The Bad, And The Ugly, John Sorrentino D.M.D.

The New York State Dental Journal

Agreeing to do a workers' compensation or no-fault case can be a great practice builder and have a powerful and positive impact on the lives of people who have been devastated by a workplace or automobile accident. Yet, many practitioners hesitate or refuse to do these kinds of cases for a variety of reasons. Often, you are dealing with insurance companies that are unfamiliar with dental claims. Perhaps because these claims don’t crop up often, you are not familiar with the process, or you have heard stories of poor, or even no reimbursement.

Strategic Cross-Subsidization In Healthcare Capitation Programs: Evidence From Medicare Advantage, Zhaowei She, Turgay Ayer, Bilal Gokpinar, Danny R. Hughesd

Research Collection Lee Kong Chian School Of Business

Problem definition: : This study identifies a resource misallocation problem in Medicare Advantage (MA), the United States' largest healthcare capitation program, which may result in discrepancies between patients' health status and the healthcare resources allocated to them. Methodology/results: : Utilizing a large commercial insurance database with claims from more than 2 million MA enrollees, this research investigates the allocation of MA capitation payments. By exploiting an exogenous policy shock on MA capitation payments through a difference-in-difference design, we find empirical evidence of an illegal practice known as "cross-subsidization." This practice involves MA health plans strategically reallocating portions of the capitation …

Central Tracking And Billing System For Insurance Bills, Kehinde Alabi

Harrisburg University Dissertations and Theses

In this article, we introduce a new centralized billing platform designed for insurance bills including auto insurance, health insurance, home insurance, life insurance, etc. This system consolidates all bills for individual users eliminating the need for them to manage and pay bills separately. Users stand to benefit from significant time and effort savings each month, reducing the likelihood of missed payments and associated late fees. Insurance billing organizations and banks can also capitalize on timely payments and reduced physical mailings, leading to cost savings and environmental benefits. The proposed system offers users the ability to track and review their historical …

Staff Matters: Assessing Health Benefits For Lgbtq+ Employees, Jodi Schafer Sphr, Shrm-Scp

The Journal of the Michigan Dental Association

To support LGBTQ+ employees, understand your health benefits by asking key questions about domestic partner coverage, mental health benefits, transgender healthcare, IVF, and surrogacy coverage, and identifying LGBTQ+-friendly providers. Regularly check in with staff to ensure benefits meet their needs and consider making changes if necessary. Proactively share benefit information throughout the year to enhance employee recruitment, retention, and engagement.

When A Health Insurance Provider Says “No”: A Health Insurance Claim Navigation Tool, Dorothy Nuckols, Catherine Sorenson

Journal of Extension

The purpose of health insurance is to pay for preventative and nonpreventative health care. Unfortunately, claim denials are frequent and most people do not contested these denials. Consumers lack both knowledge and self-efficacy to challenge their health insurance decision. Conflict is stressful can occur when a health insurance claim is denied unexpectedly. Faced with uncertainty of health care cost coverage, consumers are more likely to delay or forgo healthcare and jeopardize their health. To address this challenge, increase awareness of claim appeal processes and to provide consumer guidance, [STATE] Extension developed a Health Insurance Claim Navigation Tool.

The Financial Impact Of Correct Status Within Health Systems, Davin Evanson, Arveen Asghar, Eugene York, Michael S. Weingarten, Walter Bohnenblust

Tower Health Research Day

No abstract provided.

Financial Toxicity In Genitourinary Cancer: Insights From Cdc National Health Interview Survey, Steven Leonard Bs, Emma Helstrom Bs, Andres Correa Md, Mohit Sindhani, Nicole Uzzo, Angela Y. Jia Md Phd, Alexander Kutikov Md, Robert Uzzo Md Mba, Sarah P. Psutka Md, Adam Calaway Md Mph, Zachary Klaassen Md, Michael Staehler Md Phd, Marc Smaldone Md Mshp, Christopher Jd Wallis Md Phd, Laura Bukavina Md Mph Msc

Tower Health Research Day

No abstract provided.

The Dearth Of Knowledge Of Health Insurance Literacy Within The United States, Katherine A. Conzet

Honors Thesis

This literature review and cross-comparison were conducted to combine resources that bring to light the lack of knowledge on health insurance, the impact of this low health insurance literacy (HIL), and the lack of research being done in this subject field. This thesis analyzes and compares different research that measures HIL levels and compares these findings. At the same time, this thesis presents the complex history of health insurance and how this understanding can contribute to lower population HIL and proposes different ways to accurately measure HIL. The purpose is to show the necessity for more research into the field …

The Back Page Commentary: Care For Special Needs Patients: We Must Do Better, Craig C. Spangler Dds, Fscda

The Journal of the Michigan Dental Association

Despite strides in providing resources for neurodivergent and geriatric patients, access to suitable dental care remains a challenge. A survey revealed finding capable dentists as the primary barrier to care for special needs individuals. Transitioning from pediatric to adult care lacks continuity, highlighting gaps in predoctoral dental education. Challenges include inadequate training, limited opportunities for continuing education, and reimbursement issues. Collaboration between medical and dental leaders is crucial for addressing these pressing issues and ensuring equitable access to care.

Developing A Blueprint For Health Equity Programs And Investigating Interventions And Metrics, Belita Strudwick

MUSC Theses and Dissertations

Racial and ethnic minority groups and rural and low-income populations are examples of populations who continue to experience health disparities despite policy mandates to eliminate them. This doctoral project will provide a foundational blueprint to aid health plans in addressing and improving health equity internally and with external stakeholders. The blueprint will be based on research comparing the robust health equity initiatives of four states to the NCQA national guidelines. The barriers to achieving and recommendations for advancing the field of health equity by implementing and analyzing policies and data that target health disparities through improved access to quality care …

New Dentists’ Most-Asked Legal Questions, Dan Schulte Jd

The Journal of the Michigan Dental Association

This feature addresses new dentists' most frequently asked legal questions, offering concise answers to guide them. Topics include licensing requirements, dental record maintenance, accommodations for hearing-impaired and non-English proficient patients, the enforceability of covenants not to compete, the necessity of written employment agreements, responding to bad dental work, reporting suspected abuse, prescribing drugs to friends and family, contract terms with dental plans, and handling suspected employee theft. The article emphasizes the importance of understanding legal aspects to navigate a dental career successfully.

Staff Matters: How Can We Be More Creative With Our Benefits?, Jodi Schafer Sphr, Shrm-Scp

The Journal of the Michigan Dental Association

As open enrollment for health benefits approaches, this column discusses creative and cost-effective benefit offerings to attract and retain employees. The focus is on innovative benefits beyond traditional health, life insurance, and retirement plans. Suggestions include pet insurance, paid volunteer time, lunch and learn sessions, and flexible scheduling to accommodate employees' needs, particularly working parents and those with caregiving responsibilities. The importance of seeking employee input in benefit planning is emphasized for discovering practical, employee-desired options.

Universal Health Coverage: A Basis For Pandemic Preparedness?, Merline Feero

Independent Study Project (ISP) Collection

Amid extensive research and reporting on the effects of COVID-19 on Universal Health Coverage (UHC) progress, this study explores an often neglected topic: the potential of UHC to contribute to the foundations of pandemic preparedness. Herein, quantitative analysis reveals that countries with higher UHC coverage tend to exhibit greater pandemic preparedness (as determined by the UHC Service Coverage Index and the Global Health Security Index). Complementary qualitative analysis is used to further illustrate and explain the correlation between UHC and pandemic preparedness using four case study countries, integrating literature reviews and relevant expert interviews. Through these methods, a clear tie …

Improving Access For Children And Adults With Disabilities Through Enhanced Commercial Benefits, Holli Seabury Edd, Jeff Johnston Dds, Ms

The Journal of the Michigan Dental Association

This article explores the critical issue of accessibility to oral healthcare for people with disabilities in the United States. Delta Dental of Michigan, Ohio, and Indiana has taken a step by providing enhanced commercial benefits to children and adults with disabilities. The article delves into the challenges faced by this vulnerable population, including cost barriers and transition issues, and discusses how expanded benefits and coding, along with special dental care provisions, aim to improve access. It emphasizes the importance of proper benefits verification and presents a case study illustrating the utilization of these benefits. The article highlights the need for …

J Mich Dent Assoc March 2023

The Journal of the Michigan Dental Association

Every month, The Journal of the Michigan Dental Association brings news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members across the state. No publication reaches more Michigan dentists!

In this issue, the reader will find the following original content:

• A cover story on canceling provider agreements with dental plans.
• A clinical update on when and how to use Silver Diamine Fluoride to manage carious lesions
• News from Delta Dental on efforts to address access to care for disabled individuals through enhanced commercial dental benefits.
• The value of focused counsel from a …

Is It Time To Rip Up Your Contract? Navigating Dental Plan Participation, Stephanie Smith

The Journal of the Michigan Dental Association

This article explores the importance of dental practice management and the potential benefits of breaking away from insurance company participation agreements. The author, a practice management coach, emphasizes the role of data analysis, effective communication, and patient-centered strategies in achieving practice independence. Key areas of focus include assessing practice performance, understanding insurance reimbursement rates, and enhancing accounts receivable processes. The article provides insights into strategically transitioning to non-participation with insurance plans while preserving patient relationships. It highlights the significance of transparent communication, staff training, and timing when considering such a transition.

Is Nevada A Reproductive Resource Desert?, Tsion Mekonnen

Research Briefs

In 2018, 52.4% of Nevada adult women reported ever receiving an HPV test. Women made up 63% of all chlamydia cases and 38% of all gonorrhea cases in Nevada. 18.4% of women in Nevada reported not receiving health care at some point in the last year due to cost. While there were 180 pregnancy-associated deaths in Nevada from 2016 to 2021. Of the 180, 79 pregnancy-associated deaths were from January 2020 to December 2021 alone. Of the drug overdoses associated with pregnancy-associated deaths, 95.7% were coded as unintentional overdoses.