Delta Dental of Massachusetts has informed the Massachusetts Dental Society (MDS) that it will eliminate the restrictions on specialist referral language in the new DSM Massachusetts Insurance Company, Inc. (DMIC) provider agreements, which previously required participating providers to refer only to in-network specialists. This is in response to pressure imposed on Delta by dentists, the MDS, legislators, and others. This change does not impact the MDS’s efforts with the Division of Insurance (DOI) or legislators to address the overall issues with the Delta contract and its transition to for-profit status.
In a letter dated May 1, 2017, sent to DMIC providers, Delta indicates that “The specialist language is being removed from the DMIC Provider Agreements. More specific guidance on specialist referral has been added to the Delta Dental of Massachusetts Provider manual.” Delta states the new language in the Provider manual still encourages a dentist—“whenever possible”—to refer patients who are enrolled in DMIC plans to specialists who participate in the new DMIC PPO and Premier network, but does not bind them to this action.
Delta has finally clarified this issue, which has been a concern for many dentists since the contracts were introduced for the new for-profit DMIC. However, the MDS does not think this change is significant enough to alter our efforts with the DOI or change the position on pending legislation introduced on behalf of the MDS. Although potentially increasing access for patients, Delta refuses to reopen its network to allow dentists to join DMIC who may have not signed on in the initial offering due to this specialist language restriction.
While this is a slow process, the MDS believes it is vitally important to patients and our members that we continue our efforts. The MDS will continue to advocate for a hearing before the DOI and the Attorney General’s Office on Delta’s network transition and to push for legislation to address the issues with the new contract.
Delta also indicated in this letter that it would be revising some of the orthodontic fees in the DMIC PPO fee schedule, which has been an area of concern for many orthodontists. The new contract amendments will officially take effect on June 15, 2017.
Delta is no longer accepting dentists in the DMIC network but is offering a wait list for dentists who didn’t enroll in DMIC but now want to enroll. In addition, any member wishing to leave the network can do so by contacting Delta and providing a 60-day notice. Questions related to Delta should be directed to the Delta Professional Relations department at 617.886.1009.