We complete a two-part series this week that has examined a dilemma facing Rhode Island dentists. Specifically, that the reimbursements they receive from the state’s two major insurers – Delta Dental and Blue Cross & Blue Shield – are placing them at a competitive disadvantage.
The dentists present a strong case. For example, while Rhode Island dentists are reimbursed about $620 per crown, their counterparts in Massachusetts get at least $860 for the same service. Also, in Rhode Island dentists get about $50 for a cleaning, while their competitors in the Bay State get $80.
That formula makes it difficult for a dentist to run a business. Dentists here tell us that they often have to make up for the reimbursement shortfall by seeing a higher volume of patients. They also come up short when competing against practices in nearby Massachusetts and Connecticut for dental hygienists, assistants and clerical staff.
Seifert Systems Invests in Energy Efficiency to Strengthen Operations
For manufacturers, energy is more than just another operating expense. It plays a critical role…
Learn More
A study commissioned by the American Dental Association is expected to be released in the coming months. It looked closely at more than 200 dental markets in the United States, attempting to determine if in fact there is a correlation between the clout of insurers in certain markets and the reimbursement rates they pay to participating dentists. The ADA has yet to reach any conclusions, but about half a dozen markets from the study have been highlighted because they at least show signs that market domination by insurers may be translating into lower than usual reimbursement rates. Rhode Island, according to an ADA spokesman, is among that half-dozen.
For their part, the insurers make no apologies. They say their pay schedules are fair and are adjusted annually for inflation. They also suggest that such factors as cost of living, and the fact that in Massachusetts, at least, employers pay more in dental insurance premiums.
The insurers also suggest that the high participation rates in Rhode Island – where 90 percent of dentists participate in both plans – suggest that the reimbursement rates are adequate.
But what choice do the dentists have?
We will anxiously await the findings of the ADA study. It certainly appears that the numbers do not add up – and that at the very least someone from the state legislature should get started, digging deeper for answers.
One thing is certain, a Rhode Island business, whether it is a manufacturing operation, a financial services company or a dental practice, can not succeed if its closest competitors enjoy a significant competitive advantage.
