| GHI
benefits improved By LORRAINE SIMPKINS Group Health Incorporated (GHI) will continue to insure the state-administered dental plan. The new contract with GHI, which became effective January 1, includes some benefit enhancements and important provisions intended to improve the level of service provided to plan enrollees. For the first time, GHI will be required to meet performance guarantees set forth in the contract. Examples of these performance guarantees include the number of participating dentists, the length of time it takes to process a claim or predetermination request, as well as the time it takes to resolve an enrollee’s problem. Failure to meet these performance guarantees will result in financial penalties. In addition, GHI has opened a dedicated customer service center in Albany. The telephone number is 1-800-947-0101. The new contract also includes a modest increase in the fees paid for certain services covered by the plan. The increases, which became effective January 1, are primarily for preventive and diagnostic services. Worth noting is the fee for general anesthesia and intravenous sedation, which increased to $265 for the first 30 minutes, and $80 for each additional 15 minutes. Along with the fee schedule increases, GHI will now provide benefits for certain services that were previously not covered. Examples include “guided tissue regeneration” and some laminates (i.e. labial veneers), subject to review. Another improvement is that dentists participating in the GHI Preferred Dental Plan have been notified they can no longer require enrollees to pay for infection control, sterilization and/or other OSHA-related expenses. If you are asked by a participating dentist to pay out-of-pocket for this expense, you should contact GHI immediately. |