January 2000 Newsletter

Attendance: Bloom, Brunsden, Clemente, DeSciscio, Engel, Fertig, Glickman, Huberman, Kahn, Krantz, Leizer, Livanos, Prabhu, Schambra, Silverstein, Villa, Weiner
Acceptance of Minutes –10/12/99 minutes were not available (will be voted on at next meeting).
Treasurer’s Report:
The budget will be presented and voted on at the next general meeting (11/16/99)
Art Meisel Report:
Art Meisel addressed the board of trustees prior to the board meeting. His premise is to improve NJDA by finding out what NJDA does well and not well. The following topics were discussed:
• NJDA is filing suit against the Princeton Insurance Company so that our insured members will be reimbursed for their office interruption due to the water contamination episode.
• Nancy Dean was hired by NJDA to assist Art Meisel in the multitude of legal endeavors that NJDA is addressing. Ms. Dean is an attorney and former CFO.
• Accessibility to Art Meisel will not change when he becomes executive director.
• More money is needed to continue the success of PAC. PAC is looking for more Diamond Club members.
• NJDA is looking to improve “Officers Night” so they can better convey information to the membership. It was recommended that fewer officers speak and for a shorter amount of time.
• The NJDA Capsule will be increased to ten publications per year. NJDA would like to make it more user friendly and a better tool for conveying information to the membership.
• The NJDA Journal at the present time is published four times yearly. It may be reduced to two times a year due to the increase in publication of the Capsule. Also it was suggested that additional advertising be sought to defray the cost. More component involvement was also suggested, (i.e., component page).
• NJDA should be a clearinghouse for C.E. throughout the state to prevent overlap and redundancy of courses.
• NJDA is looking at better ways to convey information via the website and e-mail.
• NJDA would like to train spokesperson dentists for each component to actively pursue non-members.
• It was suggested that non-members be invited to the Annual Session.
• NJDA is constantly looking at ways to improve the Annual Session. It would like to offer more for the non-dentist as well as their spouses. One of the main objectives is to attract more visitors to the exhibit hall. The dates of the Annual Session are also being reviewed due to the close proximity of the NY meeting.
President’s Report-M. Schambra
• The patients’ protection bill (Norwood- Dingall) passed in the House of Representatives. The Senate bill and the House bill are far apart. A joint committee is being set up in attempt to reach an acceptable bill that can be passed.
• The dinner for Phil Cocuzza will be held at Forsgate Country Club on 11/3/99.
• Dental Care International Foundation is looking for used dental equipment that will be sent to third world countries. If anyone is interested they should contact Mr. Lou DeLaFuente at 718-831-6162.
• A motion was made to decrease the membership dues by $13 to defray the increase by the net increase of ADA’s dues. NJDA doesn’t plan to increase this year’s dues. There are 245 full paying members of MCDS. The treasury balance has increased approximately $8000/year over recent years (this doesn’t include corporate sponsorship). A vote was taken to decrease MCDS dues by $13. The vote passed, 13-Yes 1-No and 1-Abstention.
• The recording secretary will be resigning after this year. Discussion ensued regarding her replacement. Four NJDA components have executive secretaries. There will be further discussion whether or not it would be prudent for MCDS to hire an executive secretary.
Editor Reports
R. Silverstein, Layout Editor- All information should be relayed to the editors by the time of the general meeting preferably in Microsoft Word format.
Special Olympics-C. Brunsden
NJDA’s support of New Jersey Special Olympics continues. Sixty billboards are presently posted statewide. The Special Olympics is also advertising on Wheaties cereal boxes. Special Olympic videos are are also being shown on cable stations, (i.e., 30 times on MSG) throughout the metropolitan area. The video clearly demonstrates the commitment of NJDA, ”NJDA dentists help our athletes shine.” It was felt that Princeton Partners has done a great job with the advertising campaign.
NJDA Council Reports:
Long Range Planning-G. Livanos
The council is currently revising the following:
• Ten year external and internal assumptions
• Three to five year strategic plan
Membership-N.Villa
A handout of NJDA endorsed programs was given out.
Dental Education- P. DeSciscio
• Short-term emergency loans were approved up to $1000 to students who are eligible for financial aid until their loans are processed.
• An attempt will be made to provide the membership with CE courses that will appeal to the generalist and specialist (i.e., digital radiography) and provide the membership with the needed 40 biannual credits.
MCDS Committee Reports:
Mentor- E. Glickman
• Periochip will sponsor another course in the spring.
• Raj Lall will join the mentor committee as well as Gregory Livanos.
• More volunteers are sought. If interested contact Ethan Glickman.
Good & Welfare
Peter DeSciscio was made a Fellow of the American College of Dentists.
Respectfully submitted, Bruce Huberman, DMD, Secretary

NJDA sues Princeton Insurance Co. over business interruption coverage
As a consequence of “boil water” advisories issued by three water companies in the aftermath of tropical storm Floyd, a number of dentists suffered serious interruptions in their dental practices. After reviewing the terms and provisions of various insurance policies, including the one issued by Princeton Insurance Company, it appeared that Princeton may have wrongly denied coverage to NJDA member dentists.
To protect members' interests, the NJDA made available legal counsel free of charge to bring suit so that a Court could determine whether or not there is coverage. The action was filed on October 28, 1999 and will likely take many months to conclude. In the meantime, any member dentist who has a claim should promptly file it in writing with his or her insurance company. For further information, contact Arthur Meisel, Esq. (732) 422-2730, or Nancy Dean, Esq. (732) 422-2717, at the NJDA.
PIP fee schedule update
The New Jersey Department of Banking and Insurance still has not proposed a revised dental fee schedule and is now taking the position that the statutorily required biennial adjustment for inflation is discretionary and not mandatory. A motion by the NJDA in the Appellate Division for summary disposition has been denied. Accordingly, the matter will now be fully briefed and argued. Among other arguments, the NJDA will assert that the PIP fee schedule for dental services must be adjusted every two years to maintain the schedule at the reasonable and prevailing fees of 75% of the practitioners in each designated region, and that in light of the violation of the statute by the Department, an adjustment for inflation should apply retrospectively.
Aetna/Prudential consolidating PPO networks
If you are one of the almost 2000 dentists participating in the Prudential PDO program (its PPO product), effective January 1, 2000 you will automatically be added to the participating provider network of the Aetna U.S. Healthcare Dental PPO, and all of the terms and conditions of the Prudential agreement will apply to services rendered to Aetna U.S. Healthcare enrollees. If a Pru participant does not wish to be included in the combined network, he/she must notify Aetna in writing within thirty days. In that case, Prudential "may elect" to exercise the termination rights contained in the agreement (the famous "termination without cause clause").
How will this consolidation affect New Jersey Prudential participating dentists? Chances are, not much. While Aetna U.S. Healthcare is a major player on the medical side, the same does not appear to be true for dental where, at least in New Jersey, Prudential has captured more of the dental business. Further, claims for Prudential patients will continue to be processed by the current claims offices.

•MCDS reduced our dues portion $13 to make up for the $13 dues increase this year by the ADA, therefore giving their members no net dues increase for 2000. A combination of non-dues income (corporate sponsorship/advertising), savings from printing the newsletter in-house, and continued fiscal restraint by the MCDS Board has enabled us to provide our members with this benefit.

•Voluntary contributions from NJDA Members are strongly encouraged to support NJDA’s sponsorship of the Special Olympics. This is a worthwhile cause that is also providing member dentists with a targeted PR marketing campaign.

•MBNA has a credit card endorsed by NJDA that provides royalties (non-dues income) to NJDA based on usage.

Some of the terminology used with dental benefits ranges from confusing to misleading. It is almost as if it takes four years to train a dentist and five years to learn how to read and write the insurance form. In my series of tidbits, I will attempt to explain some of the terminology, some of the alphabet soup of acronyms (PPO, DMO, HMO, UCR, etc), and some of the pitfalls some doctors are falling into. All of the opinions expressed are my own; however I try to base them on current facts and information.
In the beginning there was only one model for dental benefits: the doctor performed the treatment, and the patient paid for the treatment out of his own pocket. The doctor was free to make any payment arrangements with the patient. Then about 30 years ago dental indemnity plans were coming into vogue. These were euphemistically called dental “insurance” and the name has stuck to this day. The traditional dental indemnity plan is not so much insurance, as “payment assistance”. The patient is not insured against a dental “loss”, but has some financial assistance available to offset the dental fee. The nature of the dental indemnity plan was changed when more insurance companies jumped into the market, since dental benefit plans were perceived as an untapped, profit making venture, and started to impose restrictions on them. Such restrictions took the form of benefit limitations, deductibles and review of claims to determine appropriateness of treatment. These limitations were ostensibly to decrease premiums and make the plans more competitive, but in reality they were to limit the insurance company’s financial exposure and increase their bottom line. Remember, insurance companies make money only three ways: By collecting premiums, by investing these premium dollars, and by not paying out claims.
With more and more employers deciding to give their employees dental benefits, more and more people were “insured”. Benefits were expanded to include the patient’s family so it was now feasible, if both the husband and wife worked, for both of them to have primary dental benefits and each to be covered secondarily under their spouse. It was now theoretically possible for one person’s treatment to be covered for over 100% of the fee. This loophole was exploited by patients and doctors until the insurance companies imposed coordination of benefits, where the secondary payer’s amount was reduced so reimbursement was only up to the 100% level and never exceeded it.
Within the last 10 years another interesting restriction was developed. This was called “benefit less benefit”. In this model, the secondary carrier looks at what the primary paid. The primary benefits were subtracted in the calculation of the secondary benefits, to decrease the secondary benefits. This frequently resulted in no secondary benefits being paid. Doctors and patients cried “foul”, since entitled benefits were being denied to increase the insurance company’s profitability. In addition, the premium charged to the employer was not similarly decreased because the insurance company was saving money by denying claims, and the covered employees were not getting the benefits the employer was paying for. In their defense the insurance companies claimed that this “benefit less benefit” model was built into their calculation of premiums and helped to keep the cost of insurance down. Just recently (1999) the State Department of Insurance clarified a ruling whereby insurance companies can no longer impose this restriction. They have to consider the secondary claim as if it were primary, up to 100%. One exception to this rule are plans under Federal ERISA guidelines and self-insured plans. More about this in later articles.
Daniel B. Krantz, DDS
Middlesex Representative to Council on
Dental Benefits