Reimbursement Rates Delta Dental/Other Insurances

[bergus95]

You always hear about how some states have better reimbursements than others but I’ve never been able to run across actual numbers? Does anyone have/know those?

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[yappy]

You always hear about how some states have better reimbursements than others but I’ve never been able to run across actual numbers? Does anyone have/know those?

I have wondered the same thing. A document that has dental code reimbursements by area code would be very useful.

 

[Rambunctious]

You always hear about how some states have better reimbursements than others but I’ve never been able to run across actual numbers? Does anyone have/know those?

Medi-caid reimbursement is public but delta dental wouldn't share nothing like that

 

[Roto Picante]

And there are dozens of different levels of coverage within Delta itself.

 

[gryffindor]

You won't find anything online. Dental insurance companies are very secretive about guarding their fee schedules. You could ask someone at the various PPO negotiation companies out there and they could give you an idea of better states vs worse states. Generally the fewer dentists or specialists in an area, the better the fee schedule the insurance company will put out to entice offices to join. In states where Delta is a big player for employer plans, they will have worse fee schedules. In states where Delta has to seriously compete with other companies, they may have better schedules. There can also be better fees and worse fees within states by zip code. Like New York, allowed reimbursements are higher in Manhattan than the outer boroughs, and NYC metro area reimbursements are likely generally higher than the rest of the state.

 

[yappy]

It looks like members on this board don't have an answer. If you don't know the information the OP is asking for that's okay, but don't say it doesn't exist. It obviously exists. There are companies that will provide the information for a fee.

 

[gryffindor]

It looks like members on this board don't have an answer. If you don't know the information the OP is asking for that's okay, but don't say it doesn't exist. It obviously exists. There are companies that will provide the information for a fee.

There are companies that will provide percentiles for fees in your area or zip code. You can purchase those. There are fee schedules like this available for free if you an ADA member. You can also go on Fairhealth.org and look up some typical dental codes in different zip codes to get an idea of what procedures cost.

But no one will sell you the actual fee schedules from an insurance company. Those are between then provider and the company. Some companies give the same schedule to every provider in the zip code, some give different schedules to GPs vs. specialists. Other fee schedules are unique to each provider depending on many factors such as 1) when a provider signed - some older providers are grandfathered into better schedules such as the Delta Premier vs Delta PPO debacle in some states, 2) some providers negotiated a better schedule when asked to join, 3) other providers may have just signed up for whatever the company offered not realizing that you can ask to negotiate since dental schools have typically not given their students a good business foundation and we get taken advantage of very easily.

 

[TanMan]

You always hear about how some states have better reimbursements than others but I’ve never been able to run across actual numbers? Does anyone have/know those?

You can get UCR fee schedules in your area and by percentile. Does that meet your criteria?

 

[Rambunctious]

It looks like members on this board don't have an answer. If you don't know the information the OP is asking for that's okay, but don't say it doesn't exist. It obviously exists. There are companies that will provide the information for a fee.

You literally provided no link or usable information for OP but are ok coming on here and saying everyone else's comment is useless 🤣

 

[yappy]

You literally provided no link or usable information for OP but are ok coming on here and saying everyone else's comment is useless 🤣

Somehow there is a whole industry that provides demographic reports to dentists, that includes average fee schedules and reimbursement for services by geography, but simultaneously no such information exists? I don't have the information. But like the OP, I'm interested in hearing from people who do.

Why bother commenting if you don't know? That is all I'm saying.

 

[DrJeff]

Short version, in general, the more affulent the zipcode, the higher the UCR rates, the less affulent the zipcode, the lower the UCR rates.

And in general the UCR rates over time have if anything been ticking down, and with what Cigna recently did (basically a 20% reduction in their fee schedule), expect others to follow suit soon

Over the course of one's career, you, and your staff will have countless conversations with your patients about the trials and tribulations for both the provider and the patient, of insurance companies and their policies. It is often a truly love - hate relationship for both parties

 

[DavesNotHere]

You won't find anything online. Dental insurance companies are very secretive about guarding their fee schedules. You could ask someone at the various PPO negotiation companies out there and they could give you an idea of better states vs worse states. Generally the fewer dentists or specialists in an area, the better the fee schedule the insurance company will put out to entice offices to join. In states where Delta is a big player for employer plans, they will have worse fee schedules. In states where Delta has to seriously compete with other companies, they may have better schedules. There can also be better fees and worse fees within states by zip code. Like New York, allowed reimbursements are higher in Manhattan than the outer boroughs, and NYC metro area reimbursements are likely generally higher than the rest of the state.

PPO negotiation company?

 

[gryffindor]

PPO negotiation company?

Google "dental ppo negotiations" and you will find several of them.

 

[allDAT]

Ada publishes average fees. That’s a good place to start.

Unlock the ppo, ppo advisor, ppo profits help dentists negotiate higher fee schedules. They may have a general sense of which states have better reimbursement. You could call and ask them what they think (not sure if they’ll answer your question).