The Commonwealth of Massachusetts Division of Insurance recently approved a fee schedule decrease of approximately 8.8% for Delta Dental Premier Providers, prompting many doctors to stop participating in Delta Dental of Massachusetts (DDM) plans.
DDM then began sending its patients letters instructing them that their dentist no longer would be part of the Delta Dental network, meaning they would have to pay more to get treatment from their dentist or find a new dentist in the network if they want to continue their benefits.
The Massachusetts Dental Society (MDS) took issue with this letter, and MDS president Janis Moriarty, DMD, sent an open letter to DDM president and CEO Dennis Leonard asking DDM to cease and desist sending it to patients.
“These patient communications are incomplete (and therefore misleading), intrusive of the dentist-patient relationship, and a breach of the understanding and spirit of cooperation by which Delta secured the MDS’s support for the revised Premier reimbursement methodology last year,” Moriarty wrote.
“Sending letters like these is a common practice across carriers and is not unique to Delta Dental of Massachusetts. The purpose of the letter is simple—to keep members informed so they can make the best care decisions for themselves and their families,” said Thomas O’Rourke, head of corporate communications at DDM.
“Our clients expect us to notify members when a dentist chooses to stop participating in our network, as these changes can result in increased costs for members. This transparency is vital to preventing member confusion and unexpected billing, which we hear from our members is one of their greatest areas of concern,” O’Rourke said.
Under former president Dr. David Lustbader, the MDS seemed to have a working relationship with DDM and with Leonard. Then, the MDS signed off on the 8.8% decrease in remuneration for dental services administered by DDM as an alleged compromise in negotiations.
The Massachusetts Dentists Alliance (MDA) has apparently been in continual opposition to DDM from its onset. Through the MDA’s advocacy efforts, doctors spoke out in opposition to DDM’s rate decrease, which the MDS accepted, at Massachusetts Division of Insurance public hearings. Despite these efforts, the Commonwealth approved DDM’s dental fee decreases.
In her letter, Moriarty offered five reasons why DDM’s letter was inappropriate:
- DDM’s letter informs patients that their doctor is no longer a provider with DDM, without explanation.
- DDM’s letter informs patients that their costs with a non-participating dentist will increase, without knowledge of such as fact.
- DDM’s letter coerces patients to find new dentists by disallowing assignment of benefits to non-participating doctors.
- DDM’s letter says that the fee reductions are for the patient’s benefit, as opposed to maximizing profits for the insurance company.
- DDM’s letter intrudes into the doctor-patient relationship by instructing patients to “choose a new dentist.”
“I reiterate our request that Delta immediately cease and desist from sending further communications of this nature. You are putting providers in awkward and unfair positions with respect to their patients and creating a narrative that will deserve forceful correction,” Moriarty wrote.
“And now that Delta appears willing to weaponize the assignment of benefits issue, you will further understand why it is imperative that Delta appropriately address this issue in our upcoming discussions,” Moriarty continued.
MDA organizer Jill Tanzi, DDS, is more forceful in her condemnation of DDM’s actions.
“The Alliance is impressed by MDS’s letter to Delta Dental. Sending letters to patients to coerce them into finding a new dentist without all the information is wrong and most likely illegal. It is time for MDS to file a legal complaint with the help of the ADA against these types of activities that undermine the patient-dentist relationship and patient care,” Tanzi said.
Dr. Davis practices general dentistry in Santa Fe, NM. He assists as an expert witness in dental fraud and malpractice legal cases. He currently chairs the Santa Fe District Dental Society Peer-Review Committee and serves as a state dental association member to its house of delegates. He extensively writes and lectures on related matters. He may be reached at email@example.com or smilesofsantafe.com.
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