A new Tricare Dental Plan will have active-military, National Guard, Reserve members and their families switch from MetLife to United Concordia on May 1. The contract negotiations expand some of the benefits for military families – however, dental providers may see adverse effects to their bottom line.
The five-year United Concordia contract could have a negative impact on practice collections. For one CWA pediatric client, the numbers are startling.
An analysis was done by pulling the total procedure counts for the last 12 months for all Tricare patients. It was determined their Usual and Customary Rate (UCR) fees for those procedures were about $1,175,000; MetLife reimbursed about $1 million and United Corcordia will pay them about $430,000.
If broken down even further, the average hygiene appointment for this particular pediatric practice at UCR fees is $350, MetLife paid them about $300, United Concordia Insurance will pay $128.
“This is going to affect about 30 percent of his practice’s patients, I have some clients where it will effect closer to 70 percent,” said Brenda McNulty, Chief of Pediatric and Orthodontic Development at Jameson Management. “It’s more or less something they need to be aware of, and make their decision carefully. I would recommend their accounting team and business advisors look at the numbers to see what kind of impact it will have on the practice.”
If offices are already accepting United Concordia, they will automatically be enrolled in this military contract unless they opted out by April 1. However, dentists can opt in or opt out at any time.
Steven Anderson, Founder and President of Total Patient Service, said practices should consider these three items when making their decision to opt in or out of the network:
- Total number of patients: “How many patients does the practice have that will be impacted?” Anderson said. “How a practice approaches this issue may be determined by that percentage. There is some math to be done here so that is why it needs to be done carefully.”
- Survey both options: “In the many practices that have faced similar issues, we have been able to go in and optimize their coding and billing and often find that there are huge opportunities for improvement even if they do stay on the plan,” he said. “If you look at things differently, you can get a different result.”
- How to communicate: “We typically recommend discussing this with patients verbally over the phone or face-to-face when they are in the office,” he said. “The verbal skills here are essential if the goal is to retain the patient.”
About 1.8 million people are currently enrolled in Tricare Dental Plan through MetLife, according to United Concordia. Military retirees and their families are covered separately by Delta Dental, which is a separate contract and will not be affected.