Mass. to eliminate reimbursement discount

Aug 8, 2010

The Massachusetts Division of Insurance has sided with Massachusetts dentists in their 40-year battle to eliminate a 5% discount on reimbursements imposed by Delta Dental Plan of Massachusetts, according to an ADA News story.

The Division of Insurance found the 5% discount, which Delta imposes in addition to other discounts, "exorbitant," the ADA News said. In some cases, the consumer price index used by Delta resulted in 25% discounts, according to Robert Boose, Ed.D., Massachusetts Dental Society's (MDS) executive director.

Delta Dental is reworking its methodology to eliminate the discount over the next three years. The decision will affect the 95% of the state's dentists who are providers for Delta. The new methodology will go into effect in January 2011.

"The Massachusetts Division of Insurance has approved Delta Dental of Massachusetts’ new reimbursement methodology for both the Delta Dental Premier and Delta Dental PPO networks in Massachusetts," Delta said in a statement. "The new methodology includes regional fee schedules and a gradual elimination of the current 5% discount. "

The discount was originally established to allow patients an easy way to pay and ensure that they did pay, a concept the MDS said is not as applicable now that dentists increasingly accept payments from patients by credit card, the ADA News story noted.

Also in 2011, Delta Dental of Massachusetts will introduce a program -- the first of its kind in the U.S. -- to support the work of primary care dentists in the PPO network in taking appropriate and effective preventive measures to improve the oral health of our higher risk members, the company noted.

"An important component of this program is a financial incentive that compensates dentists for successfully managing the care of our higher-risk patients," Delta said. "Dentists can choose whether or not they wish to participate in the program. This program is in line with the direction that the rest of the healthcare industry is moving in -- to emphasize prevention and disease management to achieve better health outcomes."

Delta Dental of Massachusetts said it will work with dentists to track patient care, provide data to support treatment plans, and help to ensure that appropriate preventive measures are in place to achieve and maintain optimal oral health.