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Up, Up & Away With Dental Sales Part II of Our Annual Dental Survey
Welcome to Part II of California Broker’s 2009 Dental Survey. We’ve asked the top dental providers in California to answer 28 crucial questions to help you, the agent, understand their benefits, features, and services. Look for Part II in the August issue. Read the responses and sell accordingly.
11. How many provider offices have you lost over the past 12 months? If asked, will you provide the names and phone numbers of at least three of these offices?
Aetna: 2008 annual provider turnover was 2.9%. DMO was 5%
and PPO was 2.3%.
Ameritas PPO: 1,110 provider access points were lost (FDH = 944).
Yes, we would provide names, if requested.
Blue Shield: CA DPPO: In 2008, there were 179 dentists who voluntarily terminated from our network. The voluntary turnover rate (excluding deaths, retirements and practice relocations) was 1%. CA DHMO: In 2008, there were 77 dentists who voluntarily terminated from our network. The voluntary turnover rate (excluding deaths, retirements and practice relocations) was 3%.
CIGNA Dental: While NADP has not yet released their 2008 average turnover rates, our national turnover rates are lower than the most recent NADP data. Provider information can be given to customers and brokers.
Delta Dental: All of our networks increased in size in 2008: Delta Dental Premier, by 2.55%; Delta Dental PPO by 2.2%, and DeltaCare USA, our DHMO network, by more than 3.49%. Delta Dental does not release specific information on its contracted dentists. National turnover: Premier, 0.86%; PPO, 2.57%; and DeltaCare USA, 3.31%.
GroupLink: N/A. We are not a network administrator. We do offer PPO options with our plans. Information could be got from them on request.
Dental Health Services: Although roughly 5% of participating dentists have been lost over the past 12 months, our overall network size has made up for this loss, and has increased in size by an additional 5% over the previous year. The names and phone numbers of all offices are available on request.
Golden West: The DHMO panel-retention rate average is 93%, including dental offices that have closed their practices. Golden West does not make it a practice to provide names and phone numbers of dental offices that have left the network.
Guardian: Over the past 12 months, turnover in both our DHMO and PPO nationwide network has been approximately 6%, terminating for voluntary (retirement, moving from area, closing the practice) and involuntary (terminated by network) reasons. We provide names and phone numbers of terminated offices, subject to permission from the offices. Over the past 12 months, turnover for the DHMO has been approximately 6%.
Health Net Dental: In 2008, our DHMO turnover rate for voluntary terms was 3% and our PPO turnover rate was 1% . We do not release specific information on our contracted dentists.
HumanaDental: 87 California dentists were termed during the past 12 months, including 7 that were termed by HumanaDental due to not meeting our credentialing standards. No, we will not identify terminated providers.
MetLife: For Dental PPO, our turnover rate was 1% for 2008. In California, the 2008 network turnover rate was 1%. For Dental HMO, less than 2% of contracted general dentists in California left the network in 2008.
MWG Dental Plans: The network saw a reduction in specific providers of less than .5%. This is mainly due to retiring dentists, passing away or no longer participating with managed care providers.
Principal Financial Group: For our PPO network, we’ve lost 830 providers. For our EPO network, we’ve lost 700 providers.
Securian Dental: Very few providers choose to leave the DenteMax network. Less than 3% of our network dentists discontinue participation with DenteMax every year. The majority of these terminations are due to a provider’s retirement or death or the moving or closing of a practice. We would be willing to provide names and phone numbers of terminated offices upon request.
United Concordia: In California, we retained 98% of the dentists in our PPO network and more than 93% of the dentists in our DHMO network in the last 12 months.12. What percentage of your network is closed to new enrollment? How many offices does this represent?
Aetna: For California, it is around 4%. Participating PPO dentists contractually cannot close their offices to new patients.
Ameritas PPO: Only 14 Offices (<1% of the network) are closed to new enrollment.
Anthem Blue Cross: All of our dental PPO providers are currently ac-
cepting new patients.
Blue Shield: In 2007, 2% of our DPPO network providers maintain closed practices.
CIGNA Dental: DPPO network offices do not close to new enrollment. For DHMO in California, the total number of general dentist network locations is 1,504. Of those, 1,342 are open to new enrollment.
Delta Dental: Our fee-for-service dentists do not close to new enrollment. Seven percent of DHMO dental offices are closed to new enrollment.
GroupLink: N/A, see response to Question 11.
Dental Health Services: About 5% of network dentists are closed to new enrollment.
Golden West: All of our PPO providers are accepting new patients. The DHMO providers listed on our website indicate their availability for a selected plan. The system is updated on an ongoing basis to ensure accuracy.
Guardian: In California, 10 of our 27,000+ locations of participating dentist offices are closed to new PPO patients, which represents 0.04% of our network. Nationally, 409 locations are closed to new PPO patients, representing 0.04% of our network. For the DHMO, 2% of our participating dentist offices are closed to new enrollment.
Health Net Dental: For DHMO, currently 2% (66 out of 2,976) of our offices are closed to new enrollment. For PPO, currently 1% (128 out of 8,574) of our dentists’ offices are closed to new enrollment.
HumanaDental: Under HumanaDental’s provider contract, participating dentists must schedule and treat members without discrimination, including benefit or payer differentials. Because this is a fee-for-service reimbursement program, closed practices are not common.
MetLife: Nationally, less than 1% of our participating Dental PPO dentists have requested that their names be removed from our provider listing for purposes of not accepting new MetLife-eligible patients. For Dental HMO, less than 5% of general dentist offices are closed to new enrollment in California.
MWG Dental Plans: Our network is an Open Access PPO, which is not closed to new enrollment.
Principal Financial Group: Less than 1% of the offices participating
in our network are “closed” to new enrollment.
Securian Dental: All of our network dentists are open to new enrollment.
United Concordia: In California, more than 99% of our PPO dentist network is open to new enrollment, as well as more than 98% of our DHMO dentist network.
Western Dental: Less than 3% of our network providers are closed to new enrollments - about 60 offices.13. Do all of your contracted offices accept every benefit level sold by your company or do they have the option to pick and choose only the programs with co-payments they want to accept?
Aetna: All DMO offices accept all of our coinsurance and fixed copayment plan designs. In addition, all our PPO offices accept the negotiated charge from Aetna and the patient.
Ameritas: All providers accept patients from all plans sold through Ameritas Group Dental.
Anthem Blue Cross: Anthem Blue Cross recommends all Dental Blue providers accept all plans offered. The same is true for our traditional Prudent Buyer PPO and DHMO dental plans.
Blue Shield: Offices are not allowed to “pick and choose” which
plan designs they accept.
CIGNA Dental: All contracted DPPO offices accept all of the insured benefit DPPO plan designs that we offer. All contracted DHMO offices accept all of the DHMO plan designs that we offer. For our discount dental programs, not all DPPO contracted providers are required to participate. They may opt out of participation in these discount dental programs if they desire.
Delta Dental: Delta Dental holds contracts with individual dentists for participation with each network. Dentists can choose to participate only in programs with co-payments they want to accept.
Dental Health Services: All new dentists are contracted for all plans offered by Dental Health Services.
Golden West: Most of our DHMO panel offices accept all of our plans. However, they can choose specific plans in which to participate.
Golden West: Golden West encourages all providers to accept all plans offered. The DHMO providers listed on our website indicate the plan selected by each participating provider and is updated regularly.
GroupLink: Our leased networks would track this.
Guardian: All contracted PPO offices accept all of the plan designs that we offer. All contracted CA DHMO offices accept all of the plan designs that we offer.
Health Net Dental: All participating PPO dentists accept all of our plan designs. Contracted DHMO providers accept all Health Net Dental DHMO plans.
HumanaDental: The PPO contract is for all network-based programs, excluding DHMO, which requires a separate agreement.
MetLife: For Dental PPO, all participating dentists accept all of our plan designs. They cannot pick and choose which MetLife plans to accept. For Dental HMO, when contracting with a dental-care provider, it is understood that the dentist will accept all Dental HMO plans. A few contracted dentists do not participate in some of the older custom plans.
MWG Dental Plans: Yes, all of our contracted offices accept every benefit level sold by our company.
Principal Financial Group: Providers can choose to participate in our PPO and/or EPO networks. Within each option, providers need to accept all benefit levels sold by our company.
Securian Dental: Yes, they accept every benefit level sold by our company.
United Concordia: All contracted PPO dentists accept all United Concordia PPO plans. All contracted DHMO dentists accept all United Concordia DHMO plans.
Western Dental: The entire network accepts all of the new Series 7 plans.14. Do you have a way to monitor the length of time patients have to wait in the doctor’s office?
Aetna: A Semi-annual written survey is collected from all CA DMO GP’s and specialists.
Ameritas: We monitor patient wait time through random customer and patient surveys. Providers are contacted, if necessary, to discuss specific feedback.
Anthem Blue Cross: Yes, we monitor this as a metric in our member satisfaction surveys. Through our complaint/grievance tracking processes, such issues as wait times are logged and monitored. Additionally, we monitor appointment wait times and emergency wait times through surveys conducted by our organization.
Blue Shield: Yes, we monitor and track wait times several ways. We document member complaints on this issue in our customer service workbench and track them electronically until they are resolved. We also conduct an annual member satisfaction survey, which contains specific questions about wait times with our network offices.
CIGNA Dental: The network management team monitors wait times in our DHMO general dentist facilities via monthly telephone calls. Additionally, we are able to identify lengthy wait times through our patient-satisfaction surveys.
Delta Dental: Delta Dental conducts random enrollee surveys each quarter, which include questions about the enrollee’s waiting time to schedule dentist appointments and other customer satisfaction issues. The appointment availability at DHMO offices is also monitored via regular office visits from a Delta Dental representative.
Dental Health Services: Yes, we monitor our members’ experiences through frequent member surveys and regular on-site dental office visits.
Golden West: Golden West monitors this as a metric in our member satisfaction surveys. Our complaint/grievance tracking process reviews issues such as wait times which are logged and monitored. We continue to monitor appointment wait times and emergency wait times through surveys conducted by our organization.
GroupLink: Our leased networks would track it.
Guardian: We do not monitor appointment scheduling or wait times for the PPO plan, although every month we send member satisfaction surveys, which include questions concerning wait times, to randomly chosen PPO members who have been to a network dentist within the previous 90 days. The DHMO has established access standards and monitors access quarterly mailing access monitoring forms, member satisfaction surveys, transfers, and grievance data. Telephone calls are utilized on an “as needed” basis.
Health Net Dental: We monitor individual wait times in the dentist’s waiting room through our member satisfaction surveys and provider access surveys. Results of these surveys are a critical tool in assessing a member’s experience with network dentists and their specific offices. In addition, we receive feedback on office wait times from members calling our toll-free Health Net Dental Member Services number. Reports of dissatisfaction with office wait times are investigated by Quality Management. We also monitor feedback about specific dental offices received by customer service. We continually track lengthy dentist wait times, allowing us to identify problems and correct them.
HumanaDental: We rely on member calls to keep us apprised of scheduling issues. Sometimes, the member is limiting his/her options (i.e., after 5 p.m.), which is discovered through discussion with our customer-relations representatives. If the issue becomes chronic, the information is forwarded to our National Dental Network department because additional providers may be needed in the area.
MetLife: For Dental PPO, we monitor patient impressions of “wait time” through monthly satisfaction surveys that specifically ask this question. For Dental HMO, SafeGuard, a MetLife company, monitors the length of time that patients wait in the reception area and the operatory through the quarterly accessibility survey and service visit reports by provider relations representatives. In addition, we track wait times through a monthly report and member satisfaction survey.
MWG Dental Plans: Yes in 3 ways:
1. Random calls by Professional Relations Dept to Office Managers
2. Members calling into customer service with complaints
3. Annual Member Satisfaction Surveys.
Principal Financial Group: We do not monitor this.
Securian Dental: We do not monitor this.
United Concordia: Yes, it is monitored through member surveys, a customer service grievance process and periodic phone audits of the offices.
Western Dental: Western Dental monitors patient’s length of time by on site reviews, surveys, and questionnaires. In addition, our staff model offices utilize Quality Assurance Management System a state-of-the-art, proprietary software tool that tracks measurable items, such as wait times. This ensures that our members have timely access to quality dental care.15. Are there plenty of providers who stay open late and are open on Saturdays?
Aetna: Office hours are set by each dental office. We document dentists’ office hours as part of the credentialing process. We use the information to balance networks by contracting with dentists who offer weekend and evening hours.
Ameritas PPO: Yes, each office sets its own hours. Those hours are available to all our members on our on-line provider listings. Our goal is to balance care availability throughout the area to ensure needed care.
Anthem Blue Cross: Each dental office sets its own office hours. However, as part of the credentialing process, we document dentists’ office hours and use the information to ensure our networks include dentists who offer weekend and evening hours.
Blue Shield: This varies by provider, but some do stay open late and or are open on Saturdays.
CIGNA Dental: DHMO - there are 743 network offices offering Saturday office hours, 1081 network offices with evening hours (6:00 p.m. or later). For DPPO, there are 401 network offices offering Saturday hours and 984 network offices with evening hours (6:00 p.m. or later.)
Delta Dental: Our online dentist directory contains information on hours and access, including maps and languages spoken, or enrollees can call a toll-free number to request a list of dentists in their area with extended and Saturday hours. In addition to posting hours and access, DHMO network dentists are required to provide 24-hour emergency services to DeltaCare USA enrollees at all times.
Golden West: Yes, many of our providers offer evening and Saturday appointments. Our Member Services Department can help members with details.
GroupLink: Our leased networks would need to advise on such schedules.
Guardian: Yes, many PPO and DHMO provider locations have extended or weekend hours.
Health Net Dental: The office hours of each dentist location is listed in our online provider directory. This information also is available to all members through Health Net Dental Member Services. As part of our dentist agreement, all locations are required to have an emergency contact available for members whenever the dental office is closed.
HumanaDental: Members can see the provider of their choice and are encouraged to contact their dentist for appointment availability. Based on today’s busy lifestyles, many providers are extending their hours to meet the needs of their patients.
MetLife: For Dental PPO, as part of MetLife’s credentialing criteria, all participating dentists must provide acceptable hours of service and have established emergency care and/or off-hour protocols. For Dental HMO, SafeGuard, a MetLife company, contracts with individual dental practitioners, many who have evening and Saturday hours.
Principal Financial Group: Members can see any provider of their choice which can include those who have extended hours.
MWG Dental Plans: Our provider locator on www.mwgdental.com provides members with the hours our providers are open.
Securian Dental: Yes.
United Concordia: Yes.
Western Dental: Yes, many of our IPA providers have evening and Saturday hours. The Western Dental Staff Model Offices are open from 9:00 AM to 8:00 PM, Monday through Friday and 8:00 AM to 4:00 PM on Saturdays.16. With respect to your mid-range benefit level, what is the specific amount of capitation paid to the general dentist? Do you offer validation for these amounts?
Aetna: We establish varying compensation rates under each customer’s plan for subscribers, spouses and children. Monthly compensation rates are based on case-specific dental experience, community averages, employee statistical data, and plan design. For DMO/managed dental plan, participating providers get a monthly check based on per member, per month compensation basis, subject to a guaranteed chair-hour rate. Actual capitation amounts are proprietary.
Ameritas PPO and the FDH Networks: Neither of these networks is used for dental HMO purposes, so no capitation is paid.
GroupLink: We are not a DHMO, so this is not applicable.
Delta Dental: Capitation rates are developed based on the plan design, annual utilization data, enrollee/dependent mix and employer contribution. Compensation is designed to reimburse approximately 60% to 65% of usual fees.
Guardian: Not applicable to the PPO dental products Guardian offers in California. Capitation amounts paid to the general dentist vary based on plan design, adult or child, and region.
Health Net Dental: We do not offer financial incentives to our dentists. Our expectation is that our dentists perform in accordance with high professional standards without incentives. Our extensive credentialing process ensures that our contracting dentists are of the highest caliber.
HumanaDental: Fee-for-service reimbursement encourages thorough treatment. Member complaints are reviewed by our Quality Assurance Department and through our standard grievance process.
HumanaDental: Managed dental care capitation varies by plan schedule and geographic location.
MetLife: For Dental HMO, capitation is actuarially set by plan design and that information is proprietary. Capitation is augmented by supplemental payments for certain procedures. In addition, the plan pays fees for each member visit.
MWG Dental Plans: None of our plans are capitated. All PPO general dentists are on contracted fee schedule by ADA code.
Securian Dental: We do not offer capitation plans. We offer PPO and Indemnity plans.
Western Dental: Series 7 plans reimburse providers with capitation and supplemental payments. Total compensation, as with fee for service designs, depends on how much treatment is provided.17. Are there incentives for the provider to be thorough?
Aetna: Quality management programs are designed to help protect members and providers.
Ameritas PPO: Provider thoroughness is an expectation; we do not offer an incentive for this. We do, however, monitor patient care through quarterly utilization review. If standards are not met, it could result in the provider’s termination from the network.
Anthem Blue Cross: We do not offer incentive programs to dentists, as we feel that these types of programs do not increase the quality of care. When deemed necessary and appropriate, supplemental payments may be made to participating dentists. However, these payments are not part of any bonus or incentive program.
GroupLink: This is usually asked in context of a DHMO arrangement. Providers under our programs are paid based on a fee-for-service basis or a negotiated fee schedule.
Blue Shield: Appropriate care provided by dentists in our networks is measured continuously through numerous oversight mechanisms. While routine treatment plans are carried out by dentists without prospective review, more complicated treatments are evaluated by our dental consultants. These professionals assess the proposed treatment(s) for appropriateness and benefit determination. All dentists involved in our review process are fully licensed. Our clinicians are also actively involved in the annual review of dentist records. These quality-of-care audits involve the use of comprehensive guidelines established by the American Academy of Dental Group Practice, the California Dental Association and the American Dental Association (through the University of North Carolina School of Dentistry). A random sample of each dentist’s records is selected for scrutiny by our dental consultants. Necessary recommendations are made to any dentists who do not meet our quality standards and follow-up audits are conducted to verify corrective action has been taken.
CIGNA Dental: Our Integrated Quality Management Program drives overall quality and better outcomes across our entire network. While we do not provide incentives, the expectation is that the dentists in our networks meet professionally recognized standards of care.
Dental Health Services: Our supplemental payments and rigorous quality assurance program are designed as incentives to provide appropriate and thorough care.
Golden West: Golden West does not provide monetary incentives to dentists. Our expectation is that the providers in our network meet professionally recognized standards of care, while they are expected to perform in accordance with the high standards of competence, care, and concern for the welfare and needs of participants.
Guardian: Our PPO fee schedules and plan provisions are adequate to encourage proper care. We do not offer incentives. Guardian requires participating dentists to treat PPO members the same as any other patients and we investigate all quality of care complaints from members. Our DHMO plan schedule, capitation, office visit fees, supplementals, and chair hour guarantees are adequate to encourage appropriate care. Participating dentists treat DHMO members the same as any other patient, and we have a grievance process in place to follow up on all quality of care complaints from members.
Health Net Dental: We do not offer financial incentives to our dentists. Our expectation is that our dentists perform in accordance with high professional standards without incentives. Our extensive credentialing process ensures that our contracting dentists are of the highest caliber.
HumanaDental: Fee-for-service reimbursement encourages thorough treatment. Member complaints are reviewed by our Quality Assurance Department and through our standard grievance process.
MetLife: Providers are expected to perform in accordance with high standards of competence, care, and concern for the welfare and needs of participants.
MWG Dental Plans: No, we have very strict guidelines for providers and if they do not adhere we terminate their contract.
Principal Financial Group: Being thorough is an expectation and
we do not provide incentives to meet expectations. All providers in our networks or those we might recommend must meet strict credentialing requirements. This means they have all been independently reviewed and found to have proper professional credentials and a verified history of responsible billings. However, a member is free to choose any provider.
Securian Dental: All DenteMax dentists undergo a rigorous credentialing process to ensure the highest quality dentists are treating our members.
United Concordia: Our expectation is that all services performed by participating dentists will meet the high standards of the dental industry. Participating DHMO primary dentists receive supplemental reimbursement on the most highly utilized procedures in addition to monthly capitation and member copayments, which encourages dentists to provide the services necessary to ensure the oral health of members. In addition, PPO participating dentists who consistently provide thorough service to members are given x-ray exempt status. This allows them to submit many claims without x-rays, saving them time and money.
Western Dental: Western Dental Services Inc. may pay the dentist a bonus based on exceeding standards specified by Western Dental with regard to accessibility of services and quality of care.18. Do you provide coverage for all types of specialist referrals?
Aetna: Yes.
Ameritas PPO and the FDH Networks: Yes, specialty coverage can be a part of any Ameritas plan design. Our networks are comprised of a full-spectrum of specialists to cover the needs of our customers.
Anthem Blue Cross: Yes, specialist coverage is a benefit for the Dental Blue PPO plans, but referrals are not required. Dental Blue contracted dentists are credentialed providers. And our contracted specialists, such as oral surgeons, periodontists and endodontists participate in all three Dental Blue networks. The same is true for our traditional Prudent Buyer dental PPOs.
Blue Shield: For the DHMO member there is no coverage for prosthodontic specialists. DPPO members may self refer to any specialist.
Delta Dental: Fee-for-service enrollees can visit any licensed dentist; referrals are not required for specialty care. For DHMO patients, referrals to specialists are handled by their general dentist. Prosthodontic procedures performed by the general dentist are covered, but services from a prosthodontic specialist are not covered under the DHMO plan.
Dental Health Services: Our plans provide specialty coverage for endodontics, periodontics, oral surgery, pedodontics, and orthodontics.
Golden West: Yes, all our group plans include Periodontics, Endodontics, Oral Surgery, Pedodontics and Orthodontia specialists. Individual plans are offered discounts for specialty services.
GroupLink: N/A.
Guardian: Specialty care referrals are not required under Guardian’s PPO plan. The DHMO offers Direct Referral where the member may be referred directly to a Specialist by their Primary Care Dentist without preauthorization. We provide coverage for all types of specialist dentists.
Health Net Dental: Health Net Dental DHMO plans cover a wide range of specialty care including endodontics, periodontics, oral surgery, pedodontics and orthodontics. If the procedure is covered under the plan, the member must first see general dentist for a specialty care referral to a participating specialist. The member is responsible for paying the established co-payment for the covered procedure. Our dental PPO plans cover a wide range of specialty care including endodontics, periodontics, oral surgery, pedodontics and orthodontics. Members may self-refer to the specialist of their choice, either in or out of network.
HumanaDental: Members can be referred to in-network and out-of network specialists, depending on the accessibility of the appropriate specialist in his or her area.
MetLife: For Dental PPO, claims for services by licensed dental practitioners will be considered for reimbursement based on the participant’s plan design. For Dental HMO, the SafeGuard SGX series of Dental benefit plans, available in CA, have co-payments for endodontics, periodontics, oral surgery, pedodontics, and orthodontics services provided by a participating specialist.
Principal Financial Group: Generally yes.
MWG Dental Plans: None of our plans require referrals.
Securian Dental: Our plans do not require referrals. We provide coverage based on plan benefits.
United Concordia: Our PPO plans do not require specialist referrals. Our DHMO plans require referrals for speciality coverage for endodontics, periodontics, pedodontics, oral surgery and orthodonthics.
Western Dental: Specialty coverage is available in all of our group plans. Oral surgery, periodontics, endodontics, pedodontics, and orthodontics are covered specialties.Clarification
Guardian would like to clarify its answers for questions four and five from Part I of our dental survey, which ran in the July issue. Here are the correct responses.
4. What have been the most recent changes in your plan(s)?
Guardian: Guardian constantly develops new, innovative ideas in order to meet our customers’ needs by keeping their teeth healthy and saving them money. We have introduced new features that encourage preventive care, allowing members get even more value from their annual maximums including Maximum Rollover and Preventive Advantage. Other PPO plan design enhancements include coverage of up to four periodontal treatments per year and covered as a preventative benefit, oral cancer screening exams, adult fluoride treatment coverage, cosmetic teeth whitening coverage and the ability for planholders to offer their employees three plan designs. Our new enhanced DHMO plans will waive copays after three years and include orthodontia in progress benefit and coverage for services such as oral cancer screenings and adult fluoride. We also introduced the Direct Referral program that gives DHMO members access to any in-network specialist without pre-authorization, providing faster, easier access to important treatment.5. Can an insured use his/her own dentist even if he/she is not on your “participation” list?
Guardian: Yes, members covered under our PPO plans can go to any dentist they want to use. Benefits may be paid at a lower coinsurance rate for non-participating dentists.