This year, Delta Dental of Massachusetts will begin shifting its marketing focus away from the Delta Dental Premier and Delta Dental PPO business offered under DSM to products offered under DMIC. This as a result will cause a lot of employer groups and members to choose DMIC products during plan enrollment periods over DSM products. The products under the DMIC network will be called the "DMIC PPO and Premier" network.
Currently two companies do business in Massachusetts under the Delta Dental umbrella, they are:
- Dental Service of Massachusetts, Inc. (DSM), which offers products that either use the Delta Dental Premier or the Delta Dental PPO network.
- DSM Massachusetts Insurance Company, Inc. (DMIC), which currently offers products that use Delta Dental’s Medicare Options, Patient Direct and DeltaCare networks.
For providers already participating in both the DSM PPO and DSM Premier Networks, this transition will be seamless.
For providers who currently participate only in the DSM Premier network, the following scenarios could apply:
- DSM Premier-only dentists who do not choose to participate in the new DMIC network will not see changes for any of their patients unless their patients’ employers decide to change to a new DMIC plan. If a group decides to move from a DSM plan to a DMIC plan, only then will there be a change and only for the care delivered to the members of that specific group. These providers will continue to be reimbursed at the same levels as today for any patients covered by DSM products.
- DSM Premier-only dentists who chose to participate in the new DMIC network will no longer receive Premier fees for patients covered by a DMIC PPO plan. They will receive PPO fees for services provided to these patients. These providers will continue to be reimbursed at the same levels as today for any patients covered by DSM products.
Delta Dental of Massachusetts previously agreed to extend the deadline for providers to join to 02/28/2017. After this date, any provider who has not signed the new DMIC contract will be an out-of-network provider for any DMIC PPO and DMIC Premier products. Providers can continue to serve as a Premier-only dentist under DSM if they choose to do so. DSM will continue to market and sell Premier products to Massachusetts employers. Additionally, Premier products will continue to be marketed by other Delta Dental companies to out-of-state employers with employees residing in Massachusetts. However, Delta is expecting that that a lot of patients and employer groups will start choosing the new DMIC products over the DSM products.
A dentist can terminate their DMIC agreement at any time with a 60 days written notice. Once the agreement is terminated, the dentist would be out of network for any plan administered by DMIC and out of network benefits can be different for every group. Termination from the new DMIC agreement does not impact any DSM contracts.
Although a provider can terminate the DMIC agreement at any time upon 60 days’ notice, Delta is enforcing a one-year waiting period before a provider is eligible to reapply for participation in the DMIC network after the provider terminates his or her DMIC agreement.