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Articles
2002 Annual Report Now Available
Results of Delta Dental Classic Available
Next Issue
Delta Dental's 2002 Claims and Customer Service
Performance
Visit Delta Dental at Atlantic City Conventions
Insurance Fraud: Can You Afford to Look the Other
Way?
How to Report Fraud
Fraud: An $80 Billion Per Year Crime
Preferred/Premier POS Offers Large Groups More Options, Greater Savings
Subscriber Satisfaction Levels Remain High, Says Survey
Compliance Information Centralized
Staff Spotlight: Kris Gallagher
Cost Containment Report Released
In 2002, Delta Dental added nearly 100,000 new subscribers,
while remaining firmly committed to providing outstanding
programs and customer service. These were just some
of the highlights of our 2002 Annual Report, which
is now available. Other highlights include:
- Receiving our highest marks to date in our annual
survey of benefits managers. More than 9 out of
10 benefits managers said they are "extremely
satisfied" or
"very satisfied" with Delta Dental. In
addition, 8 in 10 believe that their employees
are satisfied with Delta Dental.
- Launching our redesigned Web site, www.deltadentalnj.com.
Among the enhancements is the Claims Inquiry feature
to Benefits Connection, which allows registered
subscribers and their dentists to review claims
history and status online.
- Details of our Foundation's efforts, which include
donations for a first-of-a-kind dental clinic for
people with disabilities, two dental care clinics
for New Brunswick public school students, and critical
oral health research for minority populations.
To request a copy of the 2002 Annual Report, visit
our Web site at www.deltadentalnj.com and click on "Our
Company" on the navigation bar on the left side
of the home page.
As this issue went to press, golfers were practicing
their swings in preparation for the Thirteenth Annual
Delta Dental Classic, which has been rescheduled
to July 23. The Golf Classic raises funds for Special
Olympics New Jersey (SONJ), a non-profit organization
that provides athletic training and competition for
children and adults with mental retardation. Results
of the event will be published in the next issue
of Broker News.
Anyone who is interested in participating in or contributing
to the Delta Dental Classic should contact Jennifer
Appaluccio at jappaluccio@deltadentalnj.com.
Delta Dental's high service levels continued to
improve in 2002. Here's a glimpse at some of our
2002 performance statistics:
- We processed significantly more claims while
maintaining our speed of payment. Delta Dental
processed nearly 2.8 million claims in 2002, an
11.8% increase over 2001. Our claim cycle time
averages 8.91 business days. If your dentist submitted
electronic claims, which accounted for 41% of all
claims last year, the cycle time was even faster:
6.95 business days.
- We answered more calls faster. Customer Service
received nearly 924,000 calls, with nearly 660,000
of them handled by Customer Service agents. (The
remaining calls were handled by our automated voice
response system.) Our Customer Service agents handle
an average of more than 86 calls a day, and answer
each call in an average of 43.6 seconds.
- Our quality control remains consistently high.
Delta Dental measures performance in several key
areas, including clerical accuracy, payment accuracy
and dollar accuracy. In each area, we achieved
98.8% accuracy or higher. Our accuracy rate has
been 98% or higher on all measures since 1995.
- Our dental network continues to grow. In New
Jersey, at year-end 2002, we had 5,989 dentists
participating in DeltaPremier, 3,565 dentists participating
in Delta's Advantage Program, and 2,872 in the
DeltaPreferred Option. In Connecticut, we had 2,310
dentists participating in DeltaPremier, and 982
dentists participating in DeltaPreferred Option.
Delta Dental will be participating in the following
upcoming conventions:
New Jersey School Board Association
October 22-24, 2003
Atlantic City Convention Center
Atlantic City, New Jersey
New Jersey League of Municipalities
November 17-20, 2003
Atlantic City Convention Center
Atlantic City, New Jersey
Be sure to stop by our booth!
Organized crime has traditionally been the high-profile
target of the Department of Justice. However, the
most sought-after lawbreakers in recent years have
been those who commit healthcare fraud.
Healthcare fraud is an intentional deception or misrepresentation
that a person or entity makes knowing that the misrepresentation
could result in an incorrect payment or benefit.
Published reports estimate that medical professionals
account for about 72% of suspected healthcare fraud.
Billing for services not rendered and up-coding is
estimated to account for about 56% of this suspected
fraud.
In 1998, the State of New Jersey established healthcare
claims fraud as a separate crime carrying enhanced
penalties.
Penalties can be very severe. Guilty parties can
be providers, subscribers, insurance companies, brokers
and groups, as well as anyone knowingly benefiting
from someone else's insurance fraud. Carriers who
do business in New Jersey are required (under heavy
penalty) to report all reasonable suspicions of health
insurance fraud to the state's Office of the Insurance
Fraud Prosecutor (OIFP), which investigates and pursues
violators.
Additionally, insurance companies must maintain special
investigative units, and provide anti-fraud training
to all claims processing and underwriting staff.
We All Pay the Price for Fraud
Many people view insurance fraud as a low-risk activity
that can generate large rewards. Consumers often
feel that insurance fraud is acceptable, a crime
without an apparent victim. In truth, insurance fraud
victimizes all of us. This attitude makes it easier
for wrongdoers to operate.
Studies show that two out of three Americans will
tolerate insurance fraud to varying degrees. One
reason may have something to do with the way health
insurance policies are structured. Most health insurance
policies are structured so that the subscriber and
the insurance company share treatment costs. This
helps keep premiums lower, and helps to insure that
the services or treatments billed for were actually
rendered. Very few people will pay for something
they did not receive.
Unfortunately, many consumers do not understand their
coverage or their benefits. When people find out
they must pay expenses they assumed their insurance
would cover, they often perceive the insurance company
as being unfair. Because of this view, two-fifths
of the American public feels that there should be
little or no punishment for insurance fraud.
Most people are probably unaware of the high price
they already pay for this criminal activity. Insurance
companies must pass on the large cost of insurance
fraud to policyholders. This drives up everyone's
insurance costs and in turn causes the cost of consumer
goods to increase. Prices of clothes, appliances,
automobiles and food all rise when businesses must
pass on the higher costs of their employee health
insurance coverage. Honest businesses lose money
and may close because fraud increases their operating
costs. Individual subscriber coverage may be drained
by unnecessary or fraudulent services, and taxes
are higher because billions of tax dollars pay for
fraudulent insurance claims every year.
Health insurance fraud accounts for an estimated
10% of the annual expenditure on health care in the
United States. Studies show that a 1% rise in insurance
premiums results in approximately 400,000 more people
nationwide who cannot afford health insurance
at all.
Other types of insurance fraud include auto insurance
fraud (which costs the insurance industry an estimated
$14 billion each year), workers' compensation fraud
($2.1 billion annually), Medicaid fraud, collecting
illegal unemployment benefits, collecting illegal
Social Security disability benefits, collecting on
false homeowners' property damage, buying or selling
fake automobile insurance identification, identity
theft, and many more.
New Jersey Educates Public About Fraud
Many states, including New Jersey, have begun educating
consumers about the cost of insurance fraud. This
includes an advertising campaign geared to create
public awareness. Tips are given on how to detect
fraud, as well as how to report fraud. The messages
put out to the public stress simple themes:
1. Insurance fraud is a crime.
2. Everyone pays a high price.
3. Getting caught has heavy consequences.
4. There is a strong likelihood of getting caught.
If you think you have knowledge of a fraud, contact
the insurance carrier listed on the Explanation of
Benefits statement. The insurance company may be
reached by telephone, letter, or e-mail. Most insurance
carriers also have Web sites that contain specific
instructions for reporting fraud.
Delta Dental Plan of New Jersey can be reached at
reportfraud@deltadentalnj.com. Delta Dental also
has a Fraud Hotline at (888) 696-3262.
In the State of New Jersey you can also contact the
Office of Insurance Fraud Prosecutor at www.njinsurancefraud.org,
or at (877) 55-FRAUD (37283).
Insurance fraud is the second costliest white-collar
crime, exceeded only by tax evasion. People of all
races, incomes, and ages are victimized. The Coalition
Against Insurance Fraud estimates that insurance
fraud costs Americans $80 billion a year. Each family
pays nearly $950 in added expenses each year because
of insurance fraud; there is also an increase of
$200 to $300 in insurance premiums for the average
household.
Think of insurance fraud as an $80 billion a year
crime wave. Here's what that kind of money could
do if it weren't being fraudulently diverted:
- Fund the entire United States space program for
five years.
- Buy more than twice the gold stored at Fort Knox.
- Pay the college tuition for 12 million undergraduate
students each year.
- Fund AIDS treatment, prevention, and research
for the next eight years.
- Make insurance fraud a "Fortune 10" corporation,
if fraud was a company.
Delta Dental offers a unique plan that combines
the extensive network of our traditional DeltaPremier
Plan with the cost-savings benefits of the DeltaPreferred
Option PPO.
The DeltaPreferred Point of Service (POS) Plan operates
as a passive PPO, and is available to groups with
1,000 or more employees.
The DeltaPreferred POS Plan gives employees a choice.
They can visit a dentist who participates with the
DeltaPreferred Option and pay lower out-of-pocket
expenses. Or, they can visit any dentist who participates
with the DeltaPremier Plan and pay out-of-pocket
expenses based on negotiated DeltaPremier rates.
This plan gives employees greater flexibility regarding
their dental care, while helping them manage their
out-of-pocket expenses.
The DeltaPreferred POS Plan also saves companies
money. It costs less than the traditional DeltaPremier
Plan, while giving employees access to all DeltaPremier
Plan dentists.
The DeltaPreferred Option Network has approximately
45,000 participating dentists practicing at nearly
60,000 locations. In most cases network access is
met and even exceeded. For those subscribers who
do not utilize the services of a DeltaPreferred PPO
dentist, the DeltaPremier network is available. Nearly
three out of every four licensed dentists in the
country (more than 135,000 dental offices) participate
in the DeltaPremier network.
The DeltaPreferred POS Plan means that
employees enjoy network access to 75% of
the nation's dentists. It also offers a "safety
net" to those subscribers who otherwise may
be left without the balance billing protections
the Delta Dental networks can offer.
For more information about the DeltaPreferred
POS Plan, contact Delta Dental's Marketing
Department at (800) 624-2633, or send an
e-mail to marketing@deltadentalnj.com.
(Please note that specialists are not
reduced to PPO levels.)
Delta Dental's annual survey of members indicates
that most subscribers continue to be satisfied or
very satisfied with their Delta Dental benefits.
The 2002 Member Satisfaction Survey was conducted
by Brownstone Information Resources, a survey research
firm located in Morristown, NJ. Brownstone distributed
the survey to 6,500 randomly selected members who
had filed a claim with Delta Dental Plan of New Jersey
within the previous 12 months. From this pool, 1,585
members, or 24%, responded by the cut-off date of
January 30, 2003. Among the survey findings:
- More than 8 in 10 members are "satisfied" to "very
satisfied" with Delta Dental overall.
- More than 8 in 10 members are "satisfied" to "very
satisfied" with our Customer Service Department.
- More than 8 in 10 are "satisfied" to "very satisfied" with
the accuracy, timeliness and overall performance
of our claims processing.
- More than 9 in 10 are "satisfied" to "very satisfied" with
their dentist on all quality measures, including
quality of care and access to dental care. Nine
in 10 would use their dentist again and recommend
their dentist to a friend.
Delta Dental has created a new Compliance section
on our Web site. Features of the Compliance site
include:
- HIPAA information, including our Notice
of Privacy Practices, as well as related Web sites
and FAQs from the Office of Civil Rights.
- Print-ready compliance forms, including
authorization forms for subscribers to sign in
order for Delta Dental to release protected health
information (PHI) to third parties, and Plan Sponsor's
Certification forms A and B (in order for the sponsor
to request and/or receive PHI for plan administration
activities).
- Department of Labor (DOL) regulations,
including information about our benefit determination
and appeal process, and FAQs from the DOL.
- State Notices of Privacy Practices
- New Coordination of Benefits provisions
- New Jersey Prompt Payment Requirements
To access the new "Compliance" section of our Web
site, go to www.deltadentalnj.com and click "Compliance" on
the home page.
Kris Gallagher, service coordinator in Marketing,
joined Delta Dental in south Jersey a year and a
half ago, shortly after earning an MBA from Marymount
University in Arlington, VA.
"As a service coordinator, I wear many different
hats, but one of the most important things I do is
help Delta Dental build relationships with brokers," says
Kris. She works closely with brokers to ensure that
they, and their clients, receive what they need,
when they need it. "It can be as simple as a returned
phone call, to something a lot more extensive," says
Kris, who sometimes accompanies brokers on visits
to groups to help resolve concerns or answer questions.
Kris also works with people in other Delta Dental
departments to ensure that people internally have
the resources, tools and information necessary to
deliver what brokers and clients request.
"When I joined Delta Dental, everything here seemed like the right fit for
me, and I continue to feel that way," Kris says. "I tell people who are not
familiar with us that Delta Dental is one of the best companies to work for.
Everyone is great, the Marketing Department is phenomenal, and I've learned
things here that I never learned in college."
She adds, "I'm proud that Delta Dental, and the
account executive I support, Sal Putiri, have put
their faith and trust in me to build relationships
with brokers. Good broker relationships are extremely
important to us. Brokers are our best representatives
to existing and new groups, and we value their contribution
to Delta Dental."
Delta Dental saved groups more than $200 million
last year, thanks to our cost containment measures.
These efforts enable groups to manage their expenses
wisely while providing Delta Dental's excellent dental
benefits programs to their employees.
To view our complete "Cost Containment Report for
2002," visit our Web site at www.deltadentalnj.com
and click on "Brokers" and then "Cost Containment."
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