Q1: What should I know about Delta Dental?
Delta dental is the largest dental insurer in Massachusetts. Beginning in July of 2017, Delta Dental will start eliminating their premier network plan and is introducing a new plan called Delta Dental PPO/Premier Network (DMIC). The new plan reduces patient choices, does nothing to address underlying financial issues at Delta and burdens dentists for their mismanagement/cost (see question 5). Specifically, the new Delta PPO/Premier Plan will:
- Place treatment restrictions, including in-network specialist referral restrictions on the dentist thereby taking away the choice of making an informed decision from the patient 
- Make it harder for patients to see out-of-network dentists by not reimbursing out-of-network dentists directly. Instead, the patient would pay for services upfront and receive partial reimbursement from Delta 
- Reduce the reimbursement rate for doctors by 20-30%
In addition, instead of advertising value of its premier network dentist to the area employers and addressing underlying management/cost issues (see question 5), Delta has chosen to change their status from a not-for-profit entity to a for-profit entity
, thereby avoiding necessary regulatory oversight. The Attorney General's office is reviewing many of these concerns.
After thoroughly reviewing the new plan contract, we have concluded that the new plan incentivizes quantity over quality of service, limits patient choices, and is not consistent with our values of delivering holistic, personalized, comprehensive treatment to our patients.
We have therefore decided not to become an in-network provider for the Delta PPO/Premier DMIC plan. About 20-25% of Massachusetts dentists have made the same decision as we have.
Q2: How does it impact me?
- We are an in-network provider for Delta Dental Premier Network plan and out-of-network for Delta’s PPO plan. You will not see any changes until your new coverage period begins.
- If your employer has a multi-year contract with Delta Dental, you may still be able to pick the Delta Premier Network plan at your next open enrollment. We will remain an in-network provider for Delta Premier Network Plan.
- If approved by regulators, Delta will start advertising and selling their new DMIC plan to the area employers as early as this summer. If your employer offers this new plan and you select it, or it is your only choice, you will have the following two options when your new coverage period begins:
- You can continue to receive comprehensive dental care from our doctors. You will pay us directly. Delta will reimburse you at the reimbursement rate per your plan, up to the plan maximum limit (typically $1,000-$2,000 depending on the plan). With your authorization, we will prepare and submit insurance paperwork to Delta on your behalf. As our token of appreciation, we will provide you with a 10% discount on our standard fees.
- You can change your dental provider to an in-network provider who can provide you with the services you need. We will try our best to ensure a smooth transfer of your records. Though we will be sad to lose you, we fully understand and support your decision. Your health is our priority!
- Your employer may offer other insurance carriers such as Blue Cross/Blue shield of MA, Cigna, Aetna, Met life, Altus Dental along with Delta Dental. In this case, you may select one of these non-Delta carriers. All these plans issue payment directly to the dentist irrespective of their in-network or out-of-network status. We are in-network with Blue Cross/Blue Shield Dental Blue Indemnity, Cigna PPO, and Altus Dental.
Q3: Is there anything I can do about this change?
Of course, like in treatment, we believe education and transparency is empowering. We believe you can assist in following manner:
- Talk to and inform your employer about changes coming to Delta Dental plans. You may use this Q&A sheet.
- You can request Delta Dental to provide you with documentation about the new DMIC plan and the upcoming changes. If you have views supporting our decision, please let Delta Dental know about it by calling them or leaving reviews on their website.
- Similarly, if you believe that we have misjudged the change, please let us know. Your feedback enriches us and we promise to review your feedback very carefully.
Q4: What is the over-all issue?
Delta became market leader in Massachusetts in part by their not-for-profit charter. Now they are abusing that position by simultaneously changing to a for-profit charter on one hand while constraining patient choice and burdening dental offices with a reimbursement rate cut through this new DMIC plan contract on the other hand.
We believe that the healthcare providers, insurance industry, employers and regulators all should place patient welfare above everything else. Everyone should be held accountable for their actions and responsibilities, and no one should be allowed to abuse their power.
Q5: How is Delta Dental managing its finance?
Dental Dental's Massachusetts arm is known as Delta Service of Massachusetts (DSM). According to DSM 2015 income statement (latest available and posted on Citizen Audit website, under Financial tab), only 67% of the DSM expense was used to make benefit payments for its members. The remaining 33% was for overhead expense, including $51M or 17% for management fees! Even with such high operational cost DSM managed to make almost $38M in profit on revenue of $346M in 2015.
In our opinion Delta's DMIC plan is design to further reduce benefit payments for their member services, achieved through restrictive patient choice and 20-30% reduction in doctor reimbursement rate. By converting to a for-profit entity, DSM will further reduce oversight on their operation at a detriment of their members, employers, healthcare providers and community at large.