Delta Dental reports higher prevention utilization but member complaints about reimbursement persist

Delta Dental presented its Q1–Q3 2021 dashboard for SFHSS dental plans, showing recovering utilization and program uptake while board members raised concerns about reimbursement pressures on local dentists.

Sharon Stanek Lowe (Delta Dental) reported that 30,737 active members had at least one cleaning from Jan. 1 through Sept. 30, 2021, and about 11,070 retirees had at least one cleaning in the same period. The Smile Way wellness program had 1,672 enrollments and the vendor highlighted preventive‑category utilization (diagnostic and preventive services) is up relative to 2019 benchmarks, while basic and major services are slightly lower.

Stanek Lowe also presented a county‑level provider utilization snapshot showing both small losses and net additions to the network (for example, Alameda County showed 924 unique in‑network dentists utilized by members with a net gain when additions were counted). She said reasons for dentists leaving networks can include retirement, practice changes or shifting to concierge models, and advised the board that the new dashboard will help monitor vendor churn and geographic impacts.

Commissioners raised reports from members in Bay Area counties that some dentists are notifying patients they will no longer accept Delta reimbursement and will instead bill patients up front; commissioners asked staff to obtain a breakdown of cleanings and utilization by HMO/PPO and by network status so the board can assess out‑of‑network exposure for members. "We need to be realistic about what it means to members who are being charged the full rate," a commissioner said. Delta Dental said it would provide additional data to staff for follow‑up and recommended ongoing monitoring of provider churn.