The AAO Council on Orthodontic Health Care sponsors the Dental Benefits Advisory Service Hotline. Developed as a service to members and orthodontic staff, callers who are experiencing problems with third-party payers and carriers may call the Hotline staff at (800) 424-2841 x582 for help with these issues.

Hotline staff will discuss the issue with members or their staff to determine the nature and extent of the problem. If the matter is easily resolved, Hotline staff will offer strategies for a solution. If the problem is more detailed or becomes chronic, Hotline staff will request that an AAO Payer complaint form be completed.

If the issue raised by the AAO member office is critical, Hotline staff attempt to contact the payer for immediate relief and forward the complaint on to ADA staff for documentation and further payer dialogue and assistance.

Examples of payer issues to report are:

• Payment denial/Pre-Treatment authorization denial
  
• No direct pay to non-participating provider
  
• Benefit denial
  
• Delay in payment(s)
  
• Change in code to less complex or less expensive procedure
  
• Combined procedure(s) resulting in lower benefit
  
• Problems with/lack of coordination of benefits
  
• Requests for additional treatment information/records
  
• Loss of patient claims or additional treatment information
  
• Other (Please explain)

For help with payer issues you may contact Ann Sebaugh at (800) 424-2841 x582 or by email at asebaugh@aaortho.org. Download a copy of the AAO Third-Party Payer Complaint Form below.

AAO Member Third-Party Payer Complaint Form

 

The AAO’s new Payer Complaint form has been developed for use when members are experiencing problems with third-party payers and carriers that cannot be easily resolved by working with the AAO Dental Benefits Advisory Service staff.