Delta is not making any changes to reimbursement its existing networks. But those existing networks will empty out, Delta said, once the new PPO is in place.
Delta Dental, the largest provider of dental benefits in the state, is preparing for a change that will mean lower rates for employers and their workers -- but also lower reimbursements for dentists.
Some dentists say they won't join the new Delta Dental preferred provider organization, or PPO, even if the insurer represents 30 to 40 percent of the Massachusetts dental insurance market.
Dentists have until Jan. 31 to sign on, and have been told that patients will start migrating into the new PPO soon as their employers switch over to the less expensive plan.
"Right now we are not signing," said Dr. Thomas N. Cleary Jr. of Cleary Family Dentistry in Easthampton. "To make the switch would change the way we run our practice. For example, can we make a denture? Can we extract a tooth or is that something we would have to send out to someone else based on what Delta is offering?"
Cleary, who is in practice with his father, said the new PPO would restrict him into referring patients only to specialists who are in the network.
"I feel that it's important for a patient and a doctor to have a conversation"
about who the best specialist for the patient might be, he said.
Dr. Raymond Martin, president of the Massachusetts Dental Society and a dentist in Mansfield, said the new PPO and its rules keep dentists from sending patients where they think best. That changes what should be an honest relationship between patient and dentist, he said.
"They are driving a wedge between the patient and the dentist," Martin said.
Kristin LaRoche, senior director of public affairs for Delta Dental, said the insurance provider is building a new combined PPO to meet what she said are the evolving needs of Massachusetts employers and their workers.
PPO fees are more deeply discounted than the fees dentists are paid through the existing, but pricier, Premier network, LaRoche said.
Delta is not making any changes to reimbursements in its existing networks. But those existing networks will empty out, Delta said, once the new PPO is in place. Employers and their workers are increasingly choosing the cheaper PPO plans instead of more expensive older-style plans like Premier, she said.
Cleary said insurers never pay full price. The old Delta plan made dentists take an 18 percent writeoff. That is, under the old system, a dentist who did $100 worth of work would get $82 from Delta. Under the PPO, he said, a dentist who does $100 worth of work would get $58 from Delta.
"We would be operating at a loss," Cleary said.
It may be hard for dentists like Cleary not to sign up with the new Delta program. A quarter of his practice's 2,500 patients are Delta members. He doesn't know when those patents would start to migrate to the PPO.
"I think they feel they have control of the market because of their size," Cleary said of Delta.
He also worries if he'll be able to maintain his nine employees once Delta makes all its changes. He'll lose out no matter what: if he doesn't sign up and patients leave, or if he accepts the lower payments.
Delta's PPO makes it hard for members to see an out-of-network dentist. An out-of-network dentist wouldn't be able to get money directly from Delta. Instead, a patient would pay and get only a partial reimbursement from Delta.
State Rep. John W. Scibak, D-South Hadley, said he's working to understand the implications of Delta's move. Dentists have reached out to Scibak, who is House chairman of the state Legislative Oral Heath Caucus, and to state Sen. Harriette L. Chandler, D-Worcseter, who is the Senate chairwoman of the caucus.
They plan to meet with dentists, Delta and the state Division of Insurance in the next few weeks.
