Monday, September 14, 2009

As reported in DrBicuspid.com on July 2nd, a new law in Rhode Island prohibits insurance companies from limiting the fees of dental procedures that they do not cover. Nationally, Delta Dental has been attempting to implement a new feature of its Premier and PPO provider organization contracts that require dentists to honor their contracted fees for services that are not covered by a subscriber’s plan. This includes dental work performed by participating dentists even if not covered because the patient exhausted their annual maximum.
For years now in Minnesota, Doctors have had to take Delta write offs even after the maximum was reached. Fees on non-covered services haven’t been subjected (yet).
None of us like the idea that Delta limits fees for non-covered services (like veneers and bleaching). For one thing, how do you set a fee for such procedures when there can be such a wide range of materials and lab costs?
There are many other states where Doctors can get their full fee (not have to do Delta write offs) once the patient’s maximum has been met. The idea is that the insurance helps cover the first $1,500 or so but after that the patient is responsible. When talking with other management consultants and hearing about their strategies with Doctors in other states, they have been more willing to accept PPO discounts because they can get their full fee once the insurance maximums are reached. I think all of you heard the argument that Delta and other insurance companies should have their maximums increased to $5,000 to have the equivalent coverage of what they had 20 years ago or so. In this context it’s almost good that the maximum hasn’t been moved up.
The Rhode Island legislature voted for this because they felt that it was unfair to patients who didn’t have insurance coverage to in fact subsidize (indirectly) patients who had insurance with big write offs. Also, they felt that could affect access for patients. Rhode Island has neighboring states where the fee schedules are not as low and Delta write-offs are not as much. That gives incentive to new Dentists to not practice in Rhode Island.
Hopefully, this marks a turning point in Delta’s ability to continue to implement these policies nationwide. Maybe some day we can turn it back in Minnesota.
We have more news, free for the reading, on our website. If you have something on your mind, give me a call at 952 921 3360.
’til next time…
Posted by Bill Rossi at 9:00 AM
Labels: Advanced Practice Management, Bill Rossi, Delta Dental, Dental Consultant, Minnesota dentists, Practice Management