Aftermath: A Look at How Our Move “Out Of Network” Is Working Out

Aftermath: A Look at How Our Move “Out Of Network” Is Working Out

Insurance companies make changes they advertise as being in everyone’s best interest. At Manchester Oral Surgery, we were skeptical that was the case when Northeast Delta Dental announced changes in 2014, which led us to make the decision to no longer be a participating provider with insurance company.

Our decision to leave Delta Dental effective Jan. 1, 2015, in hindsight, has proved to be the right one for us.

First of all, it has allowed us to continue providing the same procedures without having to change our fee schedule. Any fee changes will continue to represent an increase in cost of materials, not a reaction to what an insurance company is trying to dictate to us.

We continue to concentrate on being a “quality based practice” where we can give our patients the time they deserve and need. We don’t feel it is in our patient’s best interest to schedule 45 minutes for what takes us an hour, merely to “squeeze” one more patient into the schedule. Unlike in-network practices, which can feel the stress to hurry and keep the cash register ringing to accommodate the edicts of an insurance company, we are under no pressure other than to do what is right for our patients.

Our decision also means we continue to use the materials we believe are in the best interest of our patients and not be forced to use a cheaper alternative which may compromise a patient outcome just to accommodate a bottom line mandated by an insurance company. A prime example of this would be bone preservation grafting.

Multiple studies performed on this subject documents the benefits of filling extraction sockets with bone graft materials. The material improves the quantity of available bone in the area where the tooth was extracted in order to place, stabilize and maintain the dental implant replacing the lost tooth. This is a scientifically proven method that would benefit any patient, but Delta Dental not only decided it would no longer cover this bone grafting procedure, it also set a maximum fee for what a dentist who performs this procedure can charge.

This fee was so low that we wouldn’t be able to cover the cost of the materials, forcing us to either lose money on every bone grafting procedure we performed or use cheaper materials. We thought neither alternative was acceptable – and certainly not in the best interest of our patients. We were not going to do it.

The thought of allowing an insurance company to set fees for procedures it didn’t even cover – permitted in this state when the Non-Covered services Bill failed to pass – is so fundamentally wrong, we could not go along.

And how has our decision affected our business? It really hasn’t. Our business is strong, our principles intact and we’ve kept our fees relatively unchanged.

Our bottom line is looking out for our patient’s best interest. Not the best interest of an insurance company.