1. Accept the Delta Dental PPO contract fees
2. Become an exclusive provider - accepting ONLY Delta Dental insurance
3. Terminate my provider relationship with Delta Dental
In order to evaluate the decision of staying with Delta Dental, I decided to look to FairHealthConsumer.org to find out what a "fair" price is for endodontic procedures in my region.
As a consumer, this is what FAIR health says should be charged for endodontic treatment in my zip code. If I have no insurance, this is what I should expect to pay.
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Molar RCT (D3330) 36% below the FAIR price
Bicuspid RCT (D3320) 41% below the FAIR price
Anterior RCT (D3310) 44% below the FAIR price
At SSE our current fees are BELOW the FAIR health fees for our area.
As a Premier provider with Delta Dental we are reimbursed at:
Molar RCT (D3330) 16% below the SSE Fee
Bicuspid RCT (D3320) 23% below the SSE Fee
Anterior RCT (D3310) 30% below the SSE Fee
If we become a PPO provider for Delta Dental, we will be reimbursed at:
If we become a PPO provider for Delta Dental, we will be reimbursed at:
Molar RCT (D3330) 31% below the SSE Fee
Bicuspid RCT (D3320) 42% below the SSE Fee
Anterior RCT (D3310) 48% below the SSE Fee
Looking at those reimbursements, Delta Dental PPO would become the worst reimbursing insurance company that we work with. As a business owner, at what point does it become non-profitable to see Delta patients? How does any business function at a 30-50% discount? The obvious business answer is that you have to make it up the difference in volume which typically means a decrease in the quality of service. (does corporate dentistry sound familiar?)
Looking at those reimbursements, Delta Dental PPO would become the worst reimbursing insurance company that we work with. As a business owner, at what point does it become non-profitable to see Delta patients? How does any business function at a 30-50% discount? The obvious business answer is that you have to make it up the difference in volume which typically means a decrease in the quality of service. (does corporate dentistry sound familiar?)
If you are a Premier provider, you may want to look at the numbers carefully. If you don't contact Delta by written notice, you will automatically become a PPO provider on July 1, 2014!
If you are a general dentist, the Delta PPO want to reimburse you at the following rates:
Molar RCT (D3330) 54% of the FAIR price
Bicuspid RCT (D3320) 52% of the FAIR price
Anterior RCT (D3310) 51% of the FAIR price
As a company, who was initially founded by dentists in California, Washington and Oregon and has become one of the largest dental networks in the country, this move to cut reimbursements by forcing its premier providers into the PPO network does not seem to support the dentist.
If you are a dentist in another state that has been affected by Delta Dental cuts, what has been your experience?
If you are an Arizona dentist, what are you planning to do and how do you think it will affect your practice?
If you are a dentist in another state that has been affected by Delta Dental cuts, what has been your experience?
If you are an Arizona dentist, what are you planning to do and how do you think it will affect your practice?
Some other interesting links regarding this pattern of Delta Dental to cut reimbursements to Dentists.
DentalTown Discussion regarding Delta Dental of Washington cutting reimbursements
DentalTown Discussion regarding Delta Dental of Washington cutting reimbursements
6 comments:
Thank you for referencing FAIR Health’s cost lookup tool in your post. We believe you may have misunderstood the intent of our tool, however. The charge estimates that we offer on our site are not what providers “should” charge or be reimbursed; rather, they reflect what providers are charging for a given service in that area. The estimates are based on our comprehensive database of claims information, and provide a picture of the market for medical and dental services in a given geographic region. The rates that insurers negotiate with providers will, in most cases, be less than the charges that appear on our site given the business arrangement intrinsic to insurance networks: that an insurer helps to direct a certain volume of patients to a given provider in exchange for a discount on that provider’s charges. Thus FAIR Health's cost estimates are most relevant to patients going out-of-network or those who are uninsured. Indeed, we take care to note to consumers on the site that there are many valid reasons why a given provider’s charges may vary from the estimates they receive from our tools. We are happy to offer additional information about our cost lookup tools to you or any of your readers if you would like. Please contact us at 855-301-3247.
Thank you Robin (FAIR Health) for your comments. As I understand, FAIR Health was established because an insurance company in NY also controlled the company which determined the "usual and customary fees" which was a major conflict of interest. As part of the settlement, FAIR Health was born. The FAIR health fee is a more honest and independent representation of what the "usual and customary" fee is for an area.
Insurance companies are no longer trying to tell dentists what the usual fees are in their areas. Thank you for your feedback. We welcome it!
Having read this I thought it was rather enlightening.
I appreciate you spending some time and energy to put this informative article together.
I once again find myself personally spending way
too much time both reading and commenting. But so what, it was still worth it!
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