The following is a guest post by Jonathan Ford of the Ford Dental Group. If you are interested in guest posting for Dental Heroes, please sign up here.
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the views of DentalHeroes.com.
Both of my parents are dentists and I joined them in practice about five years ago. Growing up in and around the dental practice, I always heard stories about Delta Dental and how they were founded by dentists for dentists in 1954. My parents and their dental friends also spoke about Delta Dental being the gold standard for dental insurance. However, I think dentists’ outlook on Delta is beginning to change. In my opinion, here’s why:
1. On June 15, 2011, Washington Dental Service (also know as Delta Dental of Washington) lowered all of the reimbursement rates for dentists in the state of Washington. The Premier fees were lowered by 15% and the PPO fees were decreased by 5%.
2. In the early part of 2011, Delta Dental of California froze all reimbursement rates at their current levels. Unfortunately, they did not officially announce the freeze until they sent a letter dated August 9, 2011, that stated the freeze was lifted. At our office, we submitted our fees a few days later. The results were bleak. Delta raised two or three of our procedures by $1. The rest of the fees stayed the same.
3. Within the past couple of weeks, news has trickled out from the CDA that Delta is now implementing a policy called contract adhesion. They are requiring all dentists who want to enroll in Delta Premier to also enroll in Delta PPO. As of right now, this is not affecting existing Premier-only contracted dentists. I have a hunch that might change in the future.
4. The latest actions by Delta are effective on November 1, 2011. According to ADA News, “Delta Dental of Idaho is cutting preferred provider organization reimbursement fees to dentist on regional basis by an average of 8 percent.”
From Delta Dental’s prospective, I understand that they need to offer competitive rates on their policies so companies choose them over a different company. If they don’t, they won’t stay in business. In fact, Delta did state just that in their letter to California member dentists on August 9th. It explained that a majority, if not all of the policies they were selling were the PPO and they were trying to make the premier more competitive by implementing the freeze.
Have a Little Respect
However, it would be nice of Delta to treat their dental providers with respect. I think it alienates a lot of treating dentists when they announce that there was a freeze in their fees at the exact same time they announce that the fees are unfrozen. To follow that up with a fee raise of $1 on 2-3 fees makes their actions awfully suspicious.
I understand the economy is struggling and each dentist can choose to contract or not contract with each insurance company. Each provider needs to do what is best for their own individual practice. Likewise, Delta has that right to do what’s best for its business. Most dentists would say that they are the largest private dental insurer in the country; they are already the most competitive. However, I believe there is an additional reason why Delta is taking additional steps to be more competitive, even if it starts to alienate dentists.
Most dentists do not realize that the Healthcare Reform Act is going to have an affect on the field of dentistry. The law requires all medical insurances to cover dental services for children under the age of 21. I think this is great. It gives children access to dental services, and it is definitely needed. According to the National Institute of Dental and Cranial Research, 51% of 6-11 year olds have or had a cavity in their primary teeth.
From Delta’s point of view, they have a major reason to be concerned. First, they will be losing all of their customers under the age of 21. Delta Dental is one of the few stand-alone dental insurance companies. Most insurance companies have a medical insurance side to their businesses (ex. Aetna, Cigna, and MetLife). Someone from the CDA also mentioned this key point. If you are a medical insurance company and you are already providing dental coverage to the children in a family, wouldn’t you also offer the same dental coverage to the parents? It makes the companies with medical insurance and a dental insurance component more competitive. Delta is then standing on the sidelines losing their customer base.
There are going to be a lot of changes in the dental industry over the next few years. Some people think dentistry will become like medicine and become 100% insurance-based. Others think companies will start dropping medical coverage and dentistry will be primarily fee for service. I think only time will tell.
Do you have any thoughts regarding Jonathan’s understanding of Delta’s recent moves? Please leave your thoughts in a comment below.