Insurance Connection
PDA Meets with United Concordia
On March 22 , PDA leadership and staff met with officials from United Concordia ( UCCI ) to discuss its recent policy change that caps services not provided under their dental plans . PDA ’ s representatives included Dr . William Spruill , then president-elect ; Dr . Tad Glossner , chair of the Dental Benefits Committee ; Camille Kostelac-Cherry , Esq ., chief executive officer ; and Marisa Swarney , director of government relations . UCCI was represented by James Shade , vice president of professional relations ; Karen Whitesel , corporate vice president of professional relations and product development ; and Dr . Jerome Blum , corporate dental director , professional affairs . PDA is striving to maintain open lines of communication with UCCI in order to better educate members about UCCI policies and procedures and to convey members ’ concerns and problems with some of its practices . The primary focus of this meeting was for us to express concern over how PDA members felt coerced into signing the amendment to their contracts that allow for capping non-covered services , and how a decision not to sign the amendment may affect them as participating providers .
Points made by UCCI representatives regarding its policy to set caps on non-covered services :
• The reason UCCI made this policy change was to stay competitive with other insurance companies already setting caps on non-covered services .
• In Pennsylvania , 4,100 out of 4,900 dentists signed the amendment to their contracts that now allows UCCI to set caps on non-covered services . This amounts to 85 percent of current participating providers signing the amendment .
• Unlike other insurers , UCCI maintains that this is a voluntary program for those who have contracts . Dentists who choose not to sign the amendment are still considered participating providers . Dentists who sign the amendment can never “ change their mind .”
• Moving forward , new contract holders are asked to sign contracts that already contain a provision that allows UCCI to cap fees for non-covered services .
• UCCI will conduct an annual review of fees for non-covered services . At present , UCCI provides a 5 percent discount for these services .
• UCCI is routinely discussing how to increase the number of covered services . However , it does not feel this is likely to happen given the current economic condition .
UCCI does not have plans to change this policy unless the Pennsylvania General Assembly passes legislation prohibiting this insurance practice .
As a benefit to our members , PDA makes resolving insurance problems a high priority . The Dental Benefits Committee is scheduled to meet again with UCCI – and possibly MetLife . The problems dentists encounter with these three companies are on the agenda for discussion . Committee members are dedicated to representing the dental profession and advocating for policy changes that will level the playing field for dentists .
May / June 2010 • Pennsylvania Dental Journal
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