Page 5 - Bulletin Vol 28 No 1 - Jan. - April 2023 FINAL

Message from the Editor

Thanks, But No Thanks

The following is an actual request that came to me last week. The name of my
patient and the PPO have been changed.

DR DONALD HILLS
Our member, Jane Doe, has requested you as their choice for quality
dental care! We invite you to join our PPO network, the Acme Dental
Network. As more employers offer a managed care option for dental
coverage, patients want to see in-network dentists for their family’s
care.
Benefits of being in the Acme Dental Network:

Your practice included in our online provider directory.
m Online resources, including eligibility and benefit verification.
D Dedicated staff to manage your relationship with Acme.

The Acme Dental Network agreement also includes arrangements
with several additional companies. This provides members affiliated
with those companies with in-network access to you as a participating
provider, driving even more patients to your practice.
Best Regards,

Sally Smith,
Sr. Network Specialist

So, I sat down and sent a letter to Acme.

Sally Smith,
Thank you so much for reaching out to me to join your dental PPO network. Firstly, I want to thank you
for offering me the opportunity to treat my patient for less reimbursement. That certainly sounds like a
good idea, and I like the added perk of saving your company money. I am very impressed with the online
benefits of joining Acme. As a participating dentist I can actually get listed on your website, that has to be
a good thing. My name is, after all, rather difficult for patients to type into Google when they want to find
me. The ability to check eligibility and benefit verification online is so cutting edge.

Concerning your “dental network agreement including arrangements with several additional companies,”
you didn’t include any of the fine print. I understand these arrangements so please allow me to explain
some of the fine print. Contractually, if I sign up with Acme and the “several other companies,” I will be
paid the lowest fees of any of the listed insurances. Regardless of which program a patient presents with,
my fee will be reduced to the lowest schedule. An EOB will be sent prohibiting me from charging patients
any difference. I would imagine, and it seems reasonable, you would then lower the premium charged to
the purchasers of the insurance to match the premium paid for the lowest of the plans. It is not clear in
your letter if you will, in fact, be doing such.
Although Acme is a smaller fish in the pool of PPO plans, one would think even a company of your size
would keep better tabs on practicing dentists. Let me remind you, I was a participating dentist with
Cont. on Page 8
Nassau County Dental Society ⬧ (516) 227-1112 | 5