Dental Insurance Breakdown | Impact on Dentistry

 For many dentists, it has been over 10 to 15 years since most dental insurance companies significantly increased their provider fee schedules.

Here's a breakdown:

• Stagnant Reimbursements: Most major dental insurance plans (like Delta Dental, MetLife, and United Concordia) have not consistently increased their reimbursement rates for dental procedures over the past decade.

• Inflation Disconnect: While the cost of providing care (e.g. wages, lab fees, materials, utilities, equipment) has risen sharply, insurance fee schedules have remained flat or even decreased in some regions.

• Notable Examples:

  • In many states, Delta Dental fee schedules have not changed meaningfully in 10+ years unless the dentist renegotiates individually or joins a newer plan tier.

  • Some states, like California, have passed legislation (e.g. AB 1048) trying to push for fairer rates and premium reviews.

Impact on Dentistry:

• Profit margins are shrinking, especially for solo and small group practices.

• This has helped drive consolidation into DSOs, who can negotiate better rates due to size.

• Many providers are dropping insurance plans or moving to fee-for-service models as a result. 

Indiana Dental Insurance Fee Schedule History   

In Indiana, dental insurance fee schedules have remained relatively stagnant for many years, with few significant increases.

🏥 Medicaid Fee Schedules

The Indiana Health Coverage Programs (IHCP) provides fee schedules for Medicaid services, which apply to fee-for-service (FFS) claims and serve as minimum rates for all IHCP managed care health plans.

🏢 Delta Dental Fee Schedules

Delta Dental of Indiana reviews its PPO fee schedules annually and updates them accordingly. However, specific details about the extent of these updates or historical changes in reimbursement rates are not publicly disclosed.

📊 Historical Context

A study published in 2003 noted that, as of that year, no increase in dental fees had occurred in the Indiana Medicaid program since a significant increase in 1998. This suggests that there have been periods of extended stagnation in fee schedules.

🔍 Summary

While there have been some updates to dental insurance fee schedules in Indiana, significant increases have been infrequent. The most notable change occurred in 1998, with subsequent periods of stagnation. For the most current information, it's advisable to consult directly with specific insurance providers or the Indiana Medicaid program.