Provider Reimbursement FAQ

Improving oral and overall health through quality care and education is at the core of the DDWA Mission. After extensive review, analysis and working with network dentists, we are launching a new reimbursement model. We are changing from a traditional fee for service reimbursement model to one that supports our mission where all people receive good oral health care, with no one left behind. We are excited about introducing this exciting new reimbursement model to the Washington market.

Frequently Asked Questions:  

Q: Why are you doing this?

A: Our mission is to disrupt, transform and revolutionize the oral health industry in order to remove barriers to health care and improve oral health. We recognize that network dentists are key partners in our efforts to improve oral health. By tying compensation more closely to preventive care utilization, we believe this reimbursement model supports that mission and will continue to put the focus on preventive dental care utilization visits for all our members.

Q: Why is the new model rolling out in phases?

A: At a time when other carriers are cutting or limiting reimbursements for important preventive care, the new model rewards dentists for focusing on this important type of treatment. We recognize this innovative model represents a fundamental change in our fee structure for our company, our network dentists and the Washington market. By rolling this new model out in phases, we are able closely monitor progress within our network and we see how outcomes are impacted by the model. With this model, we are taking a long-term view of reimbursements and healthier outcomes. Since dentists have the option to move to the new model – or not - we expect limited disruption in the network.

Q: How did you select the initial round of dentists to participate?

A: We used a methodology based on many factors; including preventive care utilization rates, provider market costs, network access and patient retention. The initial phase includes General Dentists and Pediatric dentists. We will monitor progress and roll out future phases, (including to Specialists), once we see how results are impacted by the model.

Q: Why are only Washington State dentists impacted by this new fee methodology?

A: This innovative fee methodology was developed by Delta Dental of Washington and, at this time, we are the only Delta Dental member company adopting it. Only claims submitted by Washington dentists are impacted by the change.

Q:  Are other Delta Dental plans considering this model?

A: We will be sharing the results of this fee methodology with interested member companies within the Delta Dental Plans Association and discussing when and how others might consider this model.

Q: Will my client need a new contract and/or benefit booklet for their covered employees?

A: No, client contracts and benefit booklets are not impacted.

Q: What is the impact to patients by this change?

A: As this first phase focuses heavily on preventive services, we anticipate minimal impact to our patients. Most of our plans provide for 100% coverage for preventive care services. Patients can log into MySmile to use the Cost Genie (cost estimator tool) and get the most accurate treatment estimates.

Q: How will you determine if this methodology is a success and what are your long-term plans for provider fees?

A: We believe any decisions we make are successful if they support our mission of better oral health for our members. We have and will continue to use network dentist insights along with a market reimbursement review to ensure the model supports our goal of increasing positive oral health outcomes for all patients. We will roll it out in phases and continue to review fees at all levels as we move forward.