09/11/2019

No 'one size fits all' when it comes to dental benefit contracting

By Cindy Hartwell, CDA Practice Support dental benefits analyst

CDA Practice Support receives calls from dentists who are considering adding or dropping participation with a dental benefit plan/network. The same question comes up repeatedly in these conversations: “Have you heard of a dentist who joined or dropped their participation with a dental benefit plan and experienced a successful transition?”

My answer is “yes.”

Typically, the caller then asks a second question: “Have you heard of a dentist who joined or dropped their participation with a dental benefit plan, which resulted in an unsuccessful transition? Again, my answer is “yes.”

It’s important to remember that adding or dropping a contract with a dental benefit plan is a personal business decision. There is no “one size fits all” in these types of business decisions, as what might work for one dentist might not work for another. 

You may be asking yourself how a dentist can make a good decision about adding or dropping a dental plan/network participation, but there is one key element in each success story and it’s this: The dentist analyzed the pros and cons of adding or dropping participation with the plan/network. The saying “If you fail to plan, you are planning to fail” certainly rings true in this situation.

I occasionally receive calls from dentists who were in contract with a dental benefit plan, then added or dropped participation with the plan/network and are now experiencing issues related to their decision. What we find is that dentists often make their decision to join a plan/network predominantly based on the fee schedule. A dentist should not make their decision to join or drop a plan/network solely based on fees.

Practice Support has resources available to help dentists consider the risks and advantages of adding or dropping a plan and/or network. These include:

  • Dental Benefit Plan Handbook - Chapter 2: Understanding Dental Benefit Plan Contracts & Fees
  • Dental Benefit Contracting: It’s not all about the fees. What you need to know before you sign
  • What You Need to Know About Dropping Dental Plan Contracts

As a CDA member, you can access these resources in the Practice Support online resource library. Simply visit cda.org/dentalbenefits and locate them under “Contracting.”

In addition to providing an online resource library, CDA Practice Support makes it easy to get answers to dental benefit questions. If you haven’t heard, CDA members can now use a simple online form to report issues and questions related to dental benefits. The online submission form lets dentists request assistance and submit their questions 24/7. In the short time since the form was launched, CDA members have remarked that the form is easy to use, fast and convenient.

While contracting or dropping participation with a plan is voluntary, CDA cautions dentists that due to antitrust laws, dentists cannot band together collectively and refuse to participate with a plan. For more information on antitrust laws, refer to the ADA’s “The Antitrust Laws in Dentistry: A Primer of Do’s, Don’ts  and How To’s for Dentists and Dental Societies.”

For resources on dental benefit plans or to report a dental benefits issue using the simple online form, visit cda.org/dentalbenefits.



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