CDA has learned that United Concordia plans to adjust reimbursement rates for its National Fee for Service Maximum Allowable Charge (MAC) schedule. United Concordia has sent letters to approximately 5,000 contracted providers in California impacted by this action. Providers in other United Concordia networks are not affected by these changes.
According to United Concordia, California is among the last 20 states to experience fee schedule adjustments, following a comparison of procedure codes and data as well as regions in which care is provided. United Concordia is telling dentists that allowances may increase, remain the same or decrease, depending on the procedure. Since this is not an across-the-board fee adjustment, providers should review their contracts to assess the full impact on their practices.
The new fee schedule is expected to go into effect April 1. A CDA-sponsored California law requires dental plans to provide dentists with 45 days' notice of any material changes to their provider contracts.
In a letter sent to providers, United Concordia states that "the marketplace for dental benefits is very competitive with purchasers [employers] demanding sustained or better benefits, lowered premiums, greater accountability and increased access."
United Concordia provider contracts do not contain the same language as the Delta Premier provider contracts that outlined the basis for CDA's current legal action against Delta.
CDA understands that you may have concerns about this change to your provider contract with United Concordia. We always recommend that you analyze your various plans and the percentage of patients in each of those plans. Resources that allow dentists to evaluate their current participating provider agreements, as well as questions to consider when contracting with new plans, can be found on cda.org. Choosing a Dental Practice Model and Evaluating Dental Benefit Plans Checklist can be accessed through your member login.
If you have questions about this or any other dental benefit plan contract, please contact CDA Dental Benefits Analyst Ann Milar at 916.554.5858.
CDA will provide additional, updated information to members about changes to United Concordia's fee changes as soon as it becomes available. For additional information, see our Frequently Asked Questions.