07/02/2013

Delta Dental of Missouri cuts provider rates


While California providers are still waiting to hear from Delta Dental of California about expected fee reductions for its Premier Plan, Missouri dentists received a letter recently from Delta Dental of Missouri that outlined plans in that state to reduce reimbursements to providers who participate in Delta’s Premier and PPO networks.

The fee reduction, which went into effect July 1, averages 7 percent. Under the new reimbursement methodology, Delta Dental of Missouri no longer requires providers to file fees. Missouri dentists were instructed to logon to the Delta website to view the new fee structure for individual provider reimbursements.

“Our competitors are offering premiums significantly below ours due to lower fee agreements with their dentist panels, and we see employers taking notice,” said David Haynes, president and CEO of Delta Dental of Missouri in the letter. “Our clients are demanding lower premiums and greater cost savings from Delta Dental of Missouri for our dental benefit plans. Many are saying they will be forced to seek other sources for dental benefits or discontinue the offering of dental benefits to their employees, if we are not able to reduce costs.”

In a separate letter sent to employer groups, Haynes outlined many of the variables impacting Delta Dental of Missouri’s decision to reduce provider reimbursement rates. The letter states that if employees continue to see a dentist who participates in its network, they will realize a reduction in out-of-pocket costs. But if they see a dentist who does not participate in Delta’s network, they will likely see an increase in out-of-pocket costs.

“Encouraging your employees to see dentists who are ‘in’ one of our networks will provide greater value for them and your program,” the letter states. “Delta Dental participating dentists have agreed to accept our fees as payment in full, and they are not allowed to balance bill for their services.”

Missouri is the latest in a string of states that have experienced provider reimbursement reductions by Delta, which has previously stated that the cuts were necessary to remain competitive and viable. In addition to Missouri, the established reimbursement reductions include:

  • Washington state: 15 percent reduction (2011)
  • Idaho: Up to 13 percent reduction (2011)
  • New Jersey: Up to 5 percent reduction (2012)
  • Connecticut: Up to 5 percent reduction (2012)

Delta Dental of California has not been forthcoming with its reasons for cutting reimbursement rates, nor has it officially informed California providers about its intentions; however, the reductions are expected to be an average of 8 to 12 percent implemented later this year. The cuts are believed to be based upon an assessment of each provider’s region and currently filed fees, not an across-the-board cut.

CDA has advocated member concerns to Delta, which responded that it would provide proper notice to all participating dentists.  CDA-sponsored legislation, AB 2252, which became law this year, requires dental plan providers to be given a 45-day notice of any material changes to the plan’s contracts and policies.

CDA recommends that dentists periodically analyze their various plans and the percentage of patients in each of those plans. To assist dentists in evaluating their current participating provider agreements with dental plans, the CDA Compass (cda.org/compass) has resources in addition to questions to consider when contracting with new plans. Choosing a Dental Practice Model and the Evaluating Dental Benefit Plans Checklist can be accessed through a member login.

CDA encourages members to check cda.org under “Quick Links” for the latest information, FAQs and resources. Members with questions about their contracts can contact CDA Dental Benefits Analyst Ann Milar by email or by phone at 916.554.4994 or our hotline at 916.554.5858.