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11/15/2010

Delta Dental-provider changes announced

Delta Dental has written to its participating dentists to advise that, as of February 1, 2011:

Rather than hold dentists to contracted rates on all services as previously announced, we will instead honor submitted fees after Feb. 1 for all non-covered services as defined in those states where such legislation has passed. Dentists will be held to their contracted fees for all other categories of service.

While this announcement is accurate in that Delta Dental cannot hold dentists in New York to contracted fees for non-covered services, this ban does not become effective on February 1. In accordance with existing New York State law, Delta Dental, like all other insurers, cannot hold doctors to contracted fees now for non-covered services and have been unable to do so for many years in New York.

Non-covered services are those treatment services that are not covered under any circumstances under a patient’s contract. Procedures for which a benefit plan provides payment equivalent to that for a less expensive alternative treatment are considered “covered services.” When reimbursement is denied because of a frequency limitation or because a patient has exceeded a maximum allowable benefit, the dentist is still held to the contracted fee, unless contractually permitted to exceed the contracted charges.

Contact NYSDA Health Affairs