Can your practice

stand to drop the major PPOs in your dental practice?

Shelley DeGroff, Founder of PPO Advisors

A big topic currently trending among providers is whether or not to drop Delta Dental. As everyone should know by now, Delta is phasing out and replacing its Premier Network with a low cost PPO network, which slashes reimbursements by 15-25%. Many dentists are unable to provide the level of care they want to give patients at the PPO rates Delta is offering.

While it may sound appealing to just drop Delta, it’s not a decision that should be taken lightly. Delta is the largest dental insurer in the U.S. serving 80 million customers. In some states like Wisconsin, Delta customers make up 80% of the market, practically a monopoly. Plus, Delta isn’t one single company; it’s an association made up of 39 independent companies, each governed by a different set of rules, which makes planning and executing a decision to leave more challenging.

I firmly believe it’s possible to be profitable without Delta, but practices should proceed with caution. If you’re thinking about dropping Delta, you can’t just wing it – you need a solid plan. To give you an idea about how to prepare, here are a few things to think about.

Research Delta Rules for Your Region

If you were to drop Cigna, MetLife, or Aetna, you could expect to follow the same process whether your practice was in Massachusetts, Michigan, or Montana. That is not true for Delta. Each of the 39 different companies that form the Delta Dental Association make their own set of rules, so it’s important to find out as much as possible about what to expect in your region.

A  dentist who recently vlogged about her experience dropping Delta Dental of California, learned that her office wouldn’t be informed about patients’ out-of-pocket benefits until after the date the practice was officially out of the network. That meant that even after she gave Delta the required 90-day notice, she wasn’t able to tell patients what the impact would be on them, upping the difficulty in her campaign to keep patients. She also learned after the fact that Delta patients with government plans wouldn’t receive any out-of-network benefits, which meant she was more likely to lose them. None of these facts deterred her, but it’s a reminder that even if you do your research and plan carefully, you should expect the unexpected.

Delta’s Out-of-Network Reimbursements Go to Patients

When Delta reimburses for out-of-network treatment, the checks go to the patient, not the practice. That means your front office has to be ready to collect payments from patients when they are in the office receiving services. Otherwise, your staff will have to spend time chasing them down. One bit of good news you can share with patients is that Delta tends to reimburse them more quickly than providers.

Offer an In-House Plan

An alternative to insurance is to offer a membership plan that entitles patients to discounts. This can be especially useful if you’re practicing in a region where Delta insurance is dominant. In-house plans help patients get real discounts on their procedures, and typically cost patients less than the dental coverage they currently have. It’s very important that patients know your in-house plan is NOT insurance. It should be set up and described as a membership or discount club. If you don’t make that distinction clear, your practice could be vulnerable to litigation from insurers, so be sure to consult with an attorney or other expert when you create your plan.

Patient Education and Team Support

To successfully drop Delta, you’ll need to get your staff on board and get their help to educate patients. Ideally, this work would be done in stages, beginning with an explanation about how Delta’s reduced benefits do not cover the level of care you are committed to providing. Give yourself enough time to have these conversations with patients before you let Delta know you’re leaving. Remember, Delta is notorious for immediately notifying patients about alternative practices where they can go to stay in-network. By then, your patients should already be aware of your decision, and know that you’ll still be able to handle Delta’s paperwork and file Delta claims. If your goal is to keep as many Delta patients as possible, it will take the support of your entire team.

Seek Out Experienced Advisors

Dropping Delta is a risky endeavor. If you get it wrong, it will be difficult for your practice to recover from the lost patients and revenue, so you can’t afford to make sudden decisions in a fit of pique. Instead, be strategic and get the support of experienced advisors.

It’s also a good idea to have a conversation directly with Delta representatives. Come prepared with a list of questions and concerns and get the facts directly from them. Find out what options they give you.

If you are feeling frustrated by your dealings with Delta or other insurance carriers, contact our team at PPO Advisors.  We help dentists navigate today’s complex insurance environment, leveling the field so dentists can build a healthy practice by working smarter, not harder.