Dentropolis is in trouble! Dental benefit plans have become so complex that patients don’t even truly understand what’s covered. Insurers are constantly changing the game, creating more and more obstacles for providers to overcome before a reimbursement is issued. And the sad financial reality is that most plans – unless we’re talking about an indemnity – won’t cover more complex services like implants and reconstructive procedures. Dentists and patients alike need a resource they can turn to, to help navigate the system and get the coverage they’re paying for.
Beginning this month, VDA members and their patients will have a new hero to turn to – Tom Bridenstine, the VDA’s first-ever Dental Benefits Expert. In his never-ending pursuit of truth and justice, Tom will help members proactively problem solve potential coverage concerns, fight denials by providing ongoing support throughout the appeals process and identify trends of improper denials with a specific insurer. Here are just a few reasons you may want to reach out to him:
- Assistance in appealing denied claims, authorizations, or pre-treatment requests
- Assistance in resolving problems such as no response, untimely response or if you disagree with the response
- How to determine what type of dental health insurance your patient has, which will determine your next steps
- Help decoding correspondence from insurers, such as explanation of benefits forms
- A resource to help explain key parts of your provider contract and informal ways to resolve problems
- Understanding why an insurer might approve an alternative benefit
- Help in submitting a formal complaint to the appropriate regulatory authority
Tom’s a super guy who can spout Code of Virginia insurance policies by memory, a knowledge-base he fine tuned during his role as Managed Care Ombudsman for State Corporation Commission’s Bureau of Insurance. Before retiring last December, Tom was the first and only person to hold the role, which was established in 1999 and helps consumers through the grievance and appeals process on managed care health insurance plans. Prior to that, Tom served 20 years the Army’s healthcare and hospital administration, where he retired as a major.
When he began preparing for his retirement from the state last fall, Tom thought back to his positive experiences in working with the VDA as Ombudsman. He’d found VDA members to be very professional and dedicated to helping their patients. Between that and the flexibility of the Dental Benefit Expert role, he signed on in January and he’s at the ready to help members improve their business relationships with insurers.
While Tom processes many super-human strengths, Superman’s enhanced hearing is not one. If you or your administrative staff would like to ask him a question and take advantage of this valuable member-only service, visit
Tom will also be offering (free) CE and writing an ongoing column in our Journal. Keep an eye out for a new video series where Tom responds to frequently asked benefits questions.