Cigna to launch rating system that ADA calls scientifically flawed
October 13, 2014
Cigna will launch in 2015 what it calls a cost-effectiveness designation program that rates in-network dentists based on cost and utilization patterns.
These ratings will appear as stars within Cigna's provider directory. According to Cigna, dentists who receive a three-star rating have a fee schedule that results in greater potential cost savings within their geographical area..
The ADA believes the methodology Cigna is using is scientifically flawed.
"We've seen carriers try to urge patients to seek treatment from dentists in their network because of discounted fee schedules, which ultimately save the carriers money. But Cigna has taken it a step further by trying to actively steer patients toward in-network dentists with the greatest discounts," said Dr. Andrew Vorrasi, 2013-14 chair of the ADA Council on Dental Benefit Programs. "The ADA doesn't have a formal relationship with Cigna but since May, CDBP has been communicating with them about this. We'll continue to talk with Cigna leaders about giving patients a clearer and more accurate picture of their dental health care options and keep ADA members informed on updates related to this ratings system."
Cigna originally planned to introduce the ratings program Nov. 1 but changed the launch date in order to keep dialoging with the dental community.
"Cigna remains committed to introducing enhancements to the mycigna.com's dental network directory that provide customers with cost transparency and insights when using their dental benefits," said Karen Eldred, Cigna spokeswoman, who added that the company welcomes a dialogue with the ADA about the program. "We have decided to postpone the introduction of the cost effectiveness designation pertaining to a network dentist's potential cost savings to 2015 rather than next month. The dental community has been providing important feedback that we are taking into consideration before including the new designations in mycigna.com
. Extending the dialogue with stakeholders helps ensure that new dental health care professional designations will be easy to understand and our customers will get the most out of every dollar when making oral health care decisions."
The issue of rating health care providers has also come up among physicians.
In 2008, Colorado state legislators enacted the Physician Designation Disclosure Act, which requires insurance companies that use a ranking system to state to patients that the information should not be the only tool in selecting a provider and that the information carries a risk of error.
The law provides physicians the opportunity to review the data and appeal their designation before a health care entity uses, changes or declines to award a designation. The law also allows physicians the right to civil action against any health care entity that violates the act. In 2007, the New York State Attorney General's office signed agreements with major medical carriers, including Cigna, requiring the carriers to follow specific guidelines when rating physicians.
Since May, the ADA has been working on this issue in partnership with the state dental associations. Most recently, the New York State Dental Association has collaborated with the ADA to report the Cigna rating system to their attorney general, and NYSDA has also sponsored legislation to prohibit dental benefit carriers from establishing ratings for dentists based on nonvalidated, unreliable metrics.
The ADA has also been working with several other state dental associations to provide information to members and has developed communication materials for state dental societies to use when answering questions about this new ranking program.
Cigna notes that it informs its customers that "the designation should not be the sole basis for their decision-making when selecting a dentist. We encourage individuals to consider all relevant factors when making dental care decisions."
The ADA believes the rating system is potentially misleading because patients may see the rating system as being about quality, Dr. Vorrasi said.
Dentists may want to appeal their rating, regardless of whether it is high or low, because of the flawed methodology. Cigna reconsiders a dentist's rating within 10 business days of receiving an appeal. A final decision is made within 90 days and is mailed to the dentist.