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Delta proposes new fee methodology in Massachusetts

June 27, 2018

By David Burger

Boston — After more than a year of acrimony, the Massachusetts Dental Society and Delta Dental of Massachusetts have come to an agreement that includes a revised fee schedule methodology proposal for the Delta Dental Premier and Delta Dental PPO networks.

The Massachusetts Dental Society said it supports the proposed changes to its Delta Dental Premier plan even though it requires dentists to take a fee reduction of 9-10 percent, said Dr. David P. Lustbader, the society's immediate past president.

In 2016, Delta launched Total Choice, a new PPO product which reimburses dentists about 25 to 30 percent less than they would receive under the current Delta Premier plan. "This PPO product was communicated to dentists with very short notice and caused considerable concern for dentists, employers and legislators," said Ellen Factor, director of dental practice and membership engagement services for the Massachusetts Dental Society.

The 2018 fee methodology proposal highlights the changing economic landscape for dentists and third-party payers across the country. Dr. Lustbader said that he understands that both sides needed to find common ground and that the dentists have to swallow a "less bitter pill. I'm not happy about it. But 10 percent is better than 30 percent fee reduction."

The agreement comes on the heels of sparring from both sides since the beginning of 2017. The Massachusetts Dental Society initiated a request in January 2017 urging the Division of Insurance to look into Delta Dental of Massachusetts' business practices. In addition, a group of Massachusetts dentists unaffiliated with the Massachusetts Dental Society filed a petition last June asking the state attorney general to investigate Delta Dental's insurance practices.

In 2017, Kristin LaRoche, spokeswoman for Delta Dental of Massachusetts, addressed the petition. "It's unfortunate that at a time that the health care community across the state is coming together to combat rising health costs, a small group of dentists are opposing our efforts to do the same in dental care," she said. "As an oral health community, we have two choices. The first is to innovate and make dental coverage more value-based and affordable. The second is to protect the status quo and threaten access to care."

Delta Dental of Massachusetts filed the revised fee schedule methodology with the Division of Insurance on June 13, 2018. The state Division of Insurance will hold a public hearing on July 12, and the division needs to approve the revised fee schedule.

"The rising costs of health care are not acceptable nor sustainable," said Dennis Leonard, president of Delta Dental of Massachusetts. "All of us in the oral health community are committed to moving towards more accountable, value-based models to control costs and improve access."

He continued: "We are pleased to announce this new proposed methodology change to our Delta Dental Premier and Delta Dental PPO networks that is the direct result of productive conversations with dentists, members and oral health partners. If approved, this change will achieve two important goals — ensuring a sustainable, predictable Premier network for providers while maintaining a competitive, more affordable option for Massachusetts customers. We know that having a strong Premier network is a priority for Massachusetts dentists and are happy to provide a lengthy window for dentists to consider these changes and look forward to productive discussions in the months to come."

The earliest that this change will go into effect is Jan. 1, 2019, giving providers time to plan for these changes and make the best decision for their individual practices, Ms. LaRoche said in June to the ADA News. "Delta has activated a question hotline and is posting video FAQs every two weeks for providers. Delta is also offering individual meetings with any dentists who want to better understand the new methodology and what it will mean for their individual practices. Dentists can speak with network specialists by calling the DDMA hotline 1-617-886-1009 or sending an email to"

The Massachusetts Dental Society will continue to update its website with additional details at