September 01, 2017
As you know all of the CCCPlus plans have included an enhanced benefit for coverage of some adult dental services. There may be some confusion or misinformation circulating so we confirmed the following with the DMAS experts last evening:
- The individuals we support currently have a limited benefit for medically necessary surgical coverage for dental care – generally this is used when anesthesia is required to do extractions of other needed procedures. The service is funded through “DentaQuest.” This service/payment option will continue as adult dental is not a Medicaid covered service and is, therefore, not a part of any plan’s required coverage.
- The enhanced benefits a for dental services are a wonderful “add-on” benefit for the individuals we support. If the dental practice that the individual currently uses is not anxious to enroll in one or more of the plans (they do not see a value added for the administrative burden to enroll compared to the limited benefit and low reimbursement), you may remind them that as dental is not a covered service but an enhanced benefit, the provider can bill the individual the balance of their fee not paid by the plan. We are now finding ways to cover routine dental care – this will, at least, reduce than burden on the individual, family and/or provider!
- It is likely that the dentist practices may be just finding out about CCCPlus as individuals are trying to select the proper plan and are calling to inquire if the dentist is within the Plan’s network. We may need to do some education!
This has also been added to the CCCPlus section of the Provider Resources