Dentists are feeling a sharp pain, thanks to Delta Dental
A plan by the state’s largest dental insurer to sell new low-cost coverage has sparked an outcry among dentists, who fear the move will cut their incomes and force them to rush through appointments.
Delta Dental of Massachusetts, which has about 2.2 million members, says the move is necessary to attract budget-conscious businesses and consumers amid a slowdown in its growth. But dentists are fighting back, arguing that the savings will come at their expense — and may prompt patients to change dentists.
Several dentists told the Globe that signing on to the new plan means accepting rates as much as 30 percent lower than they get from Delta now.
(The company said that the reduction is closer to 20 percent.)
And dentists believe that if they decline the new contract, they risk losing many longtime patients.
The rift has grown so wide that dentists are lobbying state legislators, insurance regulators, and the attorney general to intervene.
They are also considering legal action to delay or stop Delta’s changes.
The stakes are high: As many as a third or half of a typical dental practice’s patients may carry Delta insurance.
The risks are especially great for dentists who own small practices and need to pay for rent, staff, supplies, and equipment. They worry they will go the way of doctors, scrambling to see as many patients as possible each day to make a respectable salary.
“It’s moving away from quality care,” said Dr. Judy McIntyre, a dentist in Hopkinton.
After saving and planning for years, McIntyre opened her own practice in October — a milestone she had dreamed about since she was a girl. But after learning of Delta’s proposed changes, the Harvard-trained dentist, who specializes in root canals, is worried about staying in business.
“The patients are going to be the ones that suffer,” she said, “if they don’t want to be just another number in the chair.”
Delta Dental reimburses dentists differently, depending on whether they’re in the company’s Premier network or in a lower-paid preferred provider organization, known as a PPO.
The higher-paying network is far more popular among dentists. But the company is moving aggressively to expand the PPO network, by asking dentists to take patients under the new lower-cost plan.
Delta executives said they’re shifting their marketing strategy to focus on the new plan.
Dentists worry that the older, higher-paying plan will be phased out, locking them in to lower payments.
Delta also plans to limit referrals, pushing general dentists to refer patients only to specialists who are in the Delta network.
The company says this will encourage cost-effective care; dentists say it will force them to break ties with specialists they have known and trusted for years.
Initially, Delta gave dentists a few weeks to decide whether to join the new contract. But the company has extended the signing deadline by about two months, to Feb. 28.
It aims to start selling its new plan to employers this summer, pending approval from the Massachusetts Division of Insurance.
Dr. Raymond Martin, president of the Massachusetts Dental Society, said Delta’s proposed changes are worrisome, not just because of their immediate effect but because they could encourage other insurers to follow suit.
“Delta is the 800-pound gorilla,” said Martin, who practices in Mansfield. “They’re way bigger than everyone else, and they’re essentially trying to crush everyone else in the marketplace.”
For dental coverage, Delta Dental is far larger than other companies in the state, such as Blue Cross Blue Shield of Massachusetts, Aetna, Cigna, and Metlife.
But executives at Boston-based Delta said that changes are necessary to contain costs and to keep and win the business of local employers.
“We’re not seeing any growth,” said Dennis Leonard, president of Delta Dental of Massachusetts. “If your business isn’t growing, it’s dying. In order for us to continue to remain competitive, we have to make changes.”
Delta posted net income of $14 million on $186 million in revenue in the first nine months of 2016, which was down from net income of $21 million and revenue of $192 million in the same period of 2015.
Leonard said the company has fielded more than 2,000 telephone calls from dentists who are concerned about the contract changes. He said dentists are relieved when Delta officials explain that “we’re not out to destroy them.”
“We’re trying to balance the needs of the employer with the needs of the dentist,” Leonard said.
Employer groups, including the Greater Boston Chamber of Commerce and Associated Industries of Massachusetts, have signed a letter endorsing Delta Dental’s efforts.
Dentists have complained that Delta, a nonprofit, plans to sell its new product through a for-profit subsidiary, which would allow the company to avoid the greater oversight that state regulators have over nonprofits.
Leonard acknowledged Delta is making that move, noting that many of its competitors are for-profit companies and are already subject to the lesser regulations.
More than 2,800 dentists have signed on to Delta’s new contract, according to the company. But many others are waiting, still undecided about what to do.
Meanwhile, the state dental society, which represents most of Massachusetts’ more than 5,000 dentists, is trying to stop the changes. It has asked the Division of Insurance to hold a hearing to discuss Delta Dental’s plans.
“The division is continuing to consider the requested hearing,” spokesman Chris Goetcheus said in an e-mail.
“It will continue to work closely with Delta Dental to make sure its plans are transparent to consumers and dentists and to make sure all are aware of how Delta Dental is considering changes to products offered through both of its licenses.”
Dentists also asked Attorney General Maura Healey’s office to investigate. A spokeswoman said Healey’s office is reviewing the issue.
One practice bracing for change under the new Delta Dental contract is that of Drs. William and Cara Lund, who work out of Stoneham.
The father-daughter team said that signing the agreement means losing hundreds of thousands of dollars in income. They will have to make up for that, they said, by seeing more patients and by charging for more services.
“You shorten the appointments, you start charging for every little thing that you otherwise might not,” said William Lund, a general dentist for more than 40 years.
“It makes it much harder to make a living.”
Anticipating a drop in income, the Lunds have already canceled a planned office renovation.
“It’s not about dentists being greedy,” added Cara Lund. “It’s about changes in dental care.”