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October 31, 2017

Dentists critical of Delta Dental plan

Flickr/Massachusetts Office of Travel and Tourism Delta Dental's new low-cost insurance plan is receiving some criticism from dentists.

Dentists complained to the Legislature on Monday that they felt coerced into joining Delta Dental's new, lower-cost insurance plan, called Total Choice, and they asked lawmakers to impose more government control over the dental benefits giant.

Last year, Delta told dentists it was offering a new plan through a for-profit subsidiary of the non-profit parent and initially gave them about a month to sign onto the new network or face a "one-year lockout," Massachusetts Dental Society President David Lustbader told lawmakers. 

Because of Delta's market share, dentists felt they had little choice but to join the Total Choice Preferred Provider Organization (PPO), and the lower rates paid to dentists under the plan have forced them to weigh tough business decisions, they told the Committee on Financial Services. 

Lindi Ezekowitz, a pediatric dentist in Newburyport, said she couldn't afford to continue accepting both MassHealth patients and Total Choice PPO patients, so she no longer accepts Total Choice. Patients with that plan who choose to still see her must pay in full out of their own pockets.

"Those patients are suffering," Ezekowitz told the committee.

Delta Dental of Massachusetts President Dennis Leonard countered that the discounts offered through its new plan are "good news for employers and their families" and the plan is in line with state officials' goals of lowering health care costs.

"We need more affordable options in our health care market, not less," Leonard told the committee. 

Founded in 1966 as the first dental insurance company in Massachusetts, Delta operates under a different set of rules than its competitors, and must receive a sign-off from the Division of Insurance for the reimbursement rates it gives dentists, Leonard told the News Service.

"You're giving them the power to say this is fair compensation. We're the only ones that have that onerous issue around our neck," Leonard told the News Service. The new plan offered through the for-profit subsidiary is not subject to those same requirements, he said.

The Division of Insurance approved the PPO in July, Delta announced, saying that with more than 4,000 dentists participating it is "the largest dental PPO in the state."

Dentists on Monday spoke in favor of a bill (H 2197) filed by Springfield Democrat Rep. Angelo Puppolo Jr. that would require the insurance commissioner to approve all contracts between Delta and its affiliates, approve dental fees, and discourage dental insurers from attempting to influence members' choice of dentist, according to a bill summary.

The bill has the support of about 30 other lawmakers. Dentists are also pressing state regulators to look into Delta's new PPO.

Attorney General Maura Healey is reviewing Delta's actions at the request of a group of dentists, and the Massachusetts Dental Society has petitioned the Division of Insurance to hold a public hearing on the Total Choice PPO, according to the bill summary. Leonard said he could not comment on the attorney general's review but he is confident everything Delta Dental did was "above board."

"We want to do something that's more affordable. The only way you can do that is to build a lower-cost network," Leonard said. He said, "All we want to do is offer our products in the same competitive environment as other carriers in Massachusetts."

DeAnna Polin, a dental hygienist, said Delta did something similar in Washington where she used to work, and it forced dental offices to increase their patient volume to stay in business.

"The quality of care goes down," Polin told the committee.

Paul Begaan, of Incentive Group, a health care broker, said the lower-cost plan has allowed businesses to begin offering dental benefits for the first time. 

"Our clients see this as positive news for their employees and their families," Begaan wrote to the committee's co-chairmen, Sen. Jamie Eldridge and Rep. Aaron Michlewitz.

Several dentists said they felt coerced into joining the new network even though the reimbursement rates are low because they were worried about losing business if they did not agree to the terms. 

"This has been a terribly confusing ordeal for dentists," said dentist Jill Tanzi, claiming dentists signed up for the PPO because of "threats about payment lockouts, and scaring of patients away from their practices." She said, "This bullying of doctors by insurance companies need to stop."

Delta has apologized to dentists for the timing of the rollout, Leonard said. The insurer initially gave some dentists less than a month to decide if they wanted to participate, but then extended the deadline another two months, he said. 

Dentist Steve Bader said Delta "holds a monopolistic position in this market," but Leonard said Delta has about 35 percent market share in Massachusetts. The company covers 2 million members and touts itself as "the largest provider of dental benefits in the state."

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