If you are covered on the group medical plan offered through the SCDA, then by now you should have received a mailer from BlueCross / BlueShield of South Carolina (BCBSSC) referencing new pre-authorization guidelines for certain radiology and imaging services.

BCBSSC began a radiology and imaging program effective April 1, 2009 that reduces unnecessary or duplicate radiology and imaging tests.  The program requires pre-authorization for services such as magnetic resonance imaging (MRI), magnetic resonance angiogram (MRA), computed tomography (CT) and positron emission tomography (PET) scans.

The use of outpatient imaging is rapidly increasing, and imaging costs continue to grow each year.  BCBSSC is working with National Imaging Associates (NIA) to meet these challenges.  The program includes a pre-authorization process, which promotes the use of appropriate services.

As previously stated, BCBSSC began this program in April of 2009 in order to give you and your doctors enough time to familiarize yourselves with the new requirements.  Previously, they did not reduce benefits for you if your doctor didn't get pre-authorization in advance.

Effective May 1, 2011, BCBSSC will begin to enforce the radiology and imaging program penalties.  They now require pre-authorization for certain radiology and imaging services, including MRIs, MRAs, CT and PET scans.  They will require it for all doctors, regardless of the provider state location or network status.

The Pre-authorization Process -Pre-authorization is required for all outpatient imaging services in any setting (out patient facility, imaging center, physician's office, etc.)  BCBSSC does not require it in an emergency room or inpatient setting.  The provider must get the pre-authorization through NIA before rendering the service.  If pre-authorization is not obtained prior to service, BCBSSC will not reimburse the provider and the provider may bill the member.

Members are responsible for ensuring these pre-authorization requirements are met or they will be liable for the charges incurred except when they are seeking the services of a participating provider in the state of South Carolina.  If you use ANY provider outside South Carolina or ANY out-of-network provider, you are responsible for making sure the provider obtains prior authorization.

• The provider must request the authorization from NIA.
• Members can check the authorization status by logging into My Health Toolkit.

To ensure pre-authorization, simply show your ID card to your provider and ask the provider to follow the pre-authorization instructions on the back of the card.  They also recommend that you confirm the pre-authorization is on file prior to you receiving the service.

Your dental association has been offering professional malpractice insurance to its members for many years now and while you most likely have this critical coverage through the SCDA already, now may be a wise time for you to double check on this to ensure your coverage is accurate and appropriate.

The SCDA has a long standing relationship with the carriers it works with and these carriers have been operating in our great state for more than 35 years.  Stability, longevity and dependability are descriptions that come to my mind when I hear of a malpractice insurance company that has consistently been operating in one state for that duration of time. 

Speaking of dependability, these companies resolve most claims without any payment and win over 90% of the cases it defends in the courtroom.  Furthermore, SCDA members actually sit on the Boards of these companies, so you know your best interest is always in mind.

The SCDA works with companies that solely base their rates off of the dental market and who offer many different types of coverages at affordable prices.

Dental graduates can now receive discounts upwards of 65% off their first year's premium and 10% off the second year's premium. 

I can go on and on as to why you should have your professional malpractice insurance coverage through the SCDA, but in conclusion, I will remind you that when purchasing this coverage through your association, the commission dollars go back to the SCDA instead of some random outside insurance agency and of course this helps to keep your membership dues low.

It's a win-win situation anyway you look at it. 

So if you don't have your insurance coverage through the SCDA, ask yourself...why not?