Chronic payment delays to Illinois dentists who provide oral care for state employees have caused financial stress for both patients and providers, according to story in the Peoria Journal Star.
In 2011, Delta Dental of Illinois was awarded a five-year contract to administer managed care networks as part of the self-insured dental plan for state workers, retirees and dependents.
The contract involved Delta Dental receiving about $12 million from the state over the contract's term to process between $110 million and $115 million a year in dental claims for approximately 350,000 Illinois residents.
The contract was designed to save the state $8 million to $10 million annually through the use of managed care networks that weren't part of the previous contract with CompBenefits. It required in-network dentists to accept discounts of 15% to 30% from their previously charged fees in order to get more timely payments from the state, according to the story.
Patients using these in-network dentists pay less out of pocket, allowing them to extend their maximum $2,500 annual dental benefit further, according to Delta Dental.
Initially, dentists who opted out of the networks were denied direct payments from the state, and payments were sent directly to patients and dentists collected from them.
Legislation has since changed that provision, and out-of-network dentists "accepting assignment" now receive direct payments from the state. But while waiting for payment, the dentists cannot ask patients to pay more than the difference between what the state insurance pays and what the dentist charges.
In-network dentists must accept what the state pays and can't bill beyond the annual deductible, according to the story.
