Benefits administrator blog from Delta Dental

Category: Industry and policy (Page 1 of 4)

Find in-depth analysis and the latest news on the dental benefits industry.

Why leased networks don’t deliver

When it comes to dental coverage, having a large, dependable dentist network is crucial for quality dental care and reliable, cost-saving in-network access.

One of the unique advantages your employees enjoy with Delta Dental is network size. Our proprietary dentist networks are the nation’s largest. How large? Our combined Delta Dental PPO™ and Delta Dental Premier® networks feature more than 155,000 unique dentists, as of September 2021, according to Zelis Network360.

And to ensure quality care, we contract directly with each of our dentists and, most importantly, never lease our networks. That’s not the case with most other carriers, which lease dentist networks from other carriers to boost their numbers.

Of course, you might say to yourself, numbers are numbers ― if the network is large and my employees can visit a dentist, why does the type of network matter?

Because with leased networks, these numbers can be deceiving. What’s more, leased networks come with serious disadvantages for your employees.

To help understand some of these disadvantages, let’s first take a look at what leased networks are and how they work.

How leased networks work

A leased network arrangement is when one carrier agrees to share its dentist network, or a portion of it, with another carrier. A carrier can add one or many leased networks to their proprietary network.

A carrier can also share its network with a third-party insurance administrator, also known as an aggregator. Aggregators don’t own the insurance plans or pay claims. Instead, as the name suggests, aggregators lease networks from several carriers and offer participation to dentists for a fee.

Carriers profit from these arrangements by charging access fees for using their network. They may also profit from shared claim savings, which is an agreed-upon amount paid by an aggregator or carrier to the carrier whose dentist was visited to provide a service.

Leasing networks offers carriers several benefits. It allows them to expand into areas where they don’t have a network presence. It enables them to claim that they’ve increased their network size, which they can use to gain an advantage in the marketplace. And they stand to profit from access fees and shared saving.

However, these advantages for the carrier can mean disadvantages for your employees.

The downside of leased networks

Access fees

While carriers may benefit from access fees, your employees won’t. Carriers who lease networks often pass the cost of access fees on to self-funded groups by withholding claims savings. These fees can also differ from network to network.

We never charge access fees, so you can be sure your employees will get the full savings they’re entitled to.

Network size questions

Carriers that lease networks may claim that their network is “large.” But for these carriers, exactly how large can be a tough question to answer. Why? Carriers who lease networks usually have no direct contact with dentists. And since they may lease multiple networks, keeping track of dentists who leave a network, retire or fail credentialing can be a challenge. 

We update our dentist directory daily, so you know it’s accurate. And since we have relationships with our dentists, turnover is low.

Network lease timing

When you choose a dental benefits carrier, you’re locked in for the term of the contract. But that contract may not correspond to the carrier network’s lease agreements. Carrier-to-carrier leasing contracts are negotiable and can be terminated at any time. This means your employees might find the dentists they chose and depend on are suddenly no longer in their network. A leased network could lose thousands of dentists overnight.

Since we don’t lease networks, your employees can be confident knowing they can visit the dentists they know and trust.

Increased costs

When leasing contracts change, members’ expenses can increase. With renegotiated fees under a new lease, your employees may not realize their out-of-pocket costs are higher than expected until claims are processed. And these changes can happen at any time. 

That’s not the case with Delta Dental’s proprietary networks.

Inconsistent fees and billing

When a carrier leases several different dental networks, it can result in several different fee schedules, which can lead to inconsistent costs. Dentists may also be confused about how to bill enrollees, which could potentially increase the time it takes to process claims or even lead to incorrect billing. And since the leased networks are owned by different carriers, resolving any billing disputes may be difficult.

Our networks offer predictable, consistent fees and uniform billing and processing.

Quality concerns

Quality of care matters to patients and employers. But when a carrier leases multiple networks, this is difficult to guarantee. Since carriers have no relationship with the dentists in the networks they lease and contractual obligations around quality standards vary, they may not be able to confirm that these dentists’ treatment plans, safety measures and office cleanliness meet acceptable standards, nor can they guarantee that these dentists are properly credentialed.

At Delta Dental, we contract directly, maintain strong relationships and hold our dentists to high standards.


The promise of a carrier with a leased network may seem appealing, but that promise doesn’t hold up to scrutiny. With Delta Dental, you can be sure that you’ll get the network, quality and consistency that you — and your employees — can count on.

3 reasons your employees expect great dental insurance now

The pandemic has changed how we work, how we interact and how we think about our health and safety. Attitudes toward oral health have changed, too, and dental insurance has become more important than ever. 

Here are some of the top reasons why your employees expect great dental benefits now and how Delta Dental can help you provide them with what they’re looking for.

1. The pandemic has increased the need for dental benefits

Although dental offices are open and many patients have resumed regular visits, the pandemic is still taking a toll on the nation’s oral health.

Nearly half of U.S. adults reported delaying dental care due to the pandemic. And a 2021 survey showed a major increase, up to 71%, in stress-related oral health conditions during the pandemic, with more than a quarter of the dentists reporting an increase in cavities and gum disease.

Employees need strong dental plans to handle the health issues arising due to the pandemic. Comprehensive dental coverage can also help them reduce the chances for serious (and expensive) health issues down the line. 

With Delta Dental PPO™ and DeltaCare® USA plans, you can meet the demand with affordable, flexible plans with great features that encourage access to preventive care, like maximum waivers for diagnostic and preventive services.

2. Employers must boost benefits to combat the Great Resignation

The pandemic has triggered an exodus from the workforce that economists have labeled the “Great Resignation.” One of the top reasons employees are giving for leaving a job is lack of adequate benefits. 

As the pandemic reshapes the labor market, companies like yours must rethink and retool benefits to attract and retain talent. Employers who offer dental already know that employees consistently rank dental insurance as one of the most important benefits in making a job decision. Offering a comprehensive benefits package that includes robust dental coverage has become more crucial than ever.

You can help your company remain competitive by offering a dental plan that stands out. With Delta Dental, you can create or enhance plans with attractive added benefits that employees want, like coverage for popular but costly services such as implants and orthodontics.

3. Patients want teledentistry as an option

Fear of returning to the dentist caused teledentistry to boom during the pandemic, with more patients using the technology than ever before. For instance, Delta Dental’s synchronous and asynchronous teledentistry claims in 2021 were six times and two times higher than 2019 levels, respectively.

Many consumers grew accustomed to using teledentistry during the pandemic, and they want to have it as an option moving forward for its safety and convenience. Satisfaction levels with teledentistry services during the COVID-19 pandemic were 100% in the satisfied and very satisfied categories, according to one recent study, and 96% of participating patients in another study said they would use the service again.

When your employees are covered under a Delta Dental PPO or Delta Dental Premier plan, they have two options for free-to-access, easy-to-use teledentistry platforms.

And with Delta Dental, your employees can still see a dentist in person after choosing a virtual dentistry appointment. Delta Dental’s teledentistry options give your employees access to the technology they want now.

Your employees need great dental benefits in a post-pandemic world

Employees value dental benefits now more than ever. If you haven’t already, consider increasing current benefits to keep your workplace competitive in the new post-pandemic marketplace. Whatever your needs, Delta Dental is here to support your company with affordable, quality plans.

What to expect in 2022 benefits trends

In the midst of the Great Resignation, benefits are more important than ever for groups and individuals alike. About 37% of employees would rather receive more substantial benefits than additional salaries or bonuses.

That means that in-office perks like free snacks or casual dress won’t necessarily cut it on their own. Instead, job seekers are looking for more specific, long-term investments into their financial and physical well-being.

Paid family leave and child care assistance

The lines that separate work time and home life blurred significantly during the COVID-19 pandemic and employees are looking for benefits that acknowledge the realities of life. Only 40% of employers offer paid family leave for both mothers and fathers and only 6% offer child care benefits, despite both parents working full-time.

The lack of reliably safe child care during the pandemic has employees looking for financial support when it comes to child care and paid time off to take care of their kids. To build a benefits package that supports your employees and their kids, consider rebates or financial help with the costs of daycare, or even adding more paid time off to care for young children.

Voluntary benefits

Historically, companies have offered blanket benefits and resources that give the same support to all their employees. Often, benefits packages are designed to satisfy employees in key groups, like emerging talent and leadership, while other employees’ needs are prioritized much lower.

Employees with mature careers and families to care for have different priorities in mind than those who are just starting out. In 2022, many employers are looking to design more flexible benefits packages so that all employees get more of the coverage they want, with less fluff. That means adding opt-in benefits like pet insurance, critical illness plans and increased mental health support.

Flexible work arrangements

Employees want to be able to design the work-life balance they need, rather than trying to fit in to what their company has previously set. The good news is that if you’re looking to hire in 2022, flexible work will be an easy way to drive applications and retain employees.

Flexibility is the fastest growing priority for job seekers. Jobs that offer remote work receive four times the applications than onsite jobs do, LinkedIn found. But flexibility and remote work aren’t just good for getting new applications — employees who are satisfied with their work schedules and locations are more likely to enjoy working for you and recommend your workplace, according to the same study.

Expanded health services

The pandemic solidly established the connection between employee well-being and productivity ― and employers took note. About 32% of employers indicated they were working on expanding and strengthening their virtual care or telehealth programs. Another 25% said that they would increase the mental health support services offered to employees. With these kinds of benefits becoming valuable, expect to see Employee Assistance Programs (EAPs) increase in 2022 as well.

Investments for financial security

Did you know many people in America are living paycheck to paycheck? After roughly 9.6 million U.S. workers lost their jobs due to COVID-19, the stress of living without a solid financial backup has many people looking to boost their savings. Employees are looking to their employers for support when it comes to money, and they’re open to more than just a higher salary.

Employees indicate that financial benefits — like tools that automatically put part of their paycheck towards debt — would lead to less financial stress in their lives. Programs like emergency cash grants or loan programs have shown great results as well. In one study, 72% of employees who benefited from a hardship fund expressed they were more likely to stay with their employer and about 65% indicated that the fund greatly lessened their financial stress.

As you build your benefits package keep in mind that employees are looking for support from their employers. By providing flexible, specific benefits that keep your employees mentally, physically and financially strong, you’re investing in a happier and more productive work force.

COVID-19 by the numbers

The early days of the pandemic brought a tidal wave of changes to businesses and their employees. Navigating this new normal can be tricky, especially since the situation seems to be changing daily. Looking at the changes that occurred during the pandemic can help you understand what trends to anticipate and how to prepare your benefits offerings accordingly.

Let’s take a high-level look at how COVID-19 impacted workers, dentists and the dental insurance industry, as well as a deep dive into claims data, patient surveys and expert opinion.

The rise of teledentistry

During the early stages of the pandemic in the United States, dental offices were closed to physical appointments for weeks. This led to a massive surge in the popularity of teledentistry services. Synchronous appointments (those with live phone or video interaction between dentists and their patients) saw a 3,000% increase between 2019 and 2020, according to Delta Dental claims during that period. Asynchronous appointments (where patients took photos or videos that were sent to a dentist for later review) saw a 1,000% increase in the same period.

The use of teledentistry has declined as the pandemic has worn on and dentist offices have reopened, but 2021’s synchronous and asynchronous appointment numbers still remain six times and two times higher than 2019 levels, respectively.

More states also updated their teledentistry laws during the pandemic. Based on Delta Dental’s internal tracking, 14 states added teledentistry regulations to their laws or expanded existing regulations, including states such as Texas that previously hadn’t allowed the practice of teledentistry at all.

Most importantly, in a phone survey of teledentistry patients during the pandemic, patients expressed widespread satisfaction with their options. This aligns with pre-pandemic expectations about teledentistry. Of those surveyed before the pandemic, 78% expected to use teledentistry within the next five years. That same group anticipated that working people, children and people with disabilities would benefit the most from teledentistry.

Dentists also had praise for teledentistry, with over 80% of dentists identifying it as useful for improving access to oral care, increasing specialists’ access to rural and underserved communities and as a time-saving technique. 

Virtual visits may not replace in-person checkups, but they remain a valuable tool for employees to get expert opinions and feedback when they can’t make it into the dentist office or prefer a remote appointment.

Providing alternatives for employees who can’t make it to the dentist office

The beginning of the pandemic was marked by profound economic uncertainty as dental practices closed and people sheltered in place. General practitioner income dropped nearly 18% in 2020 compared to 2019.

To help keep dental practices open and seeing patients, Delta Dental offered network dentists loans and reimbursements for personal protective equipment (PPE) costs and made free teledentistry tools available to members.

Loans offered in partnership with Provide (formerly Lendeavor) allowed dentists to make purchases, stay on top of debts and pay staff to ensure that they could keep their doors open. Delta Dental also offered a supplemental reimbursement to help offset the costs of PPE and office cleanings, ensuring that dentist offices remained safe for staff and patients alike.

The pandemic saw the rollout of two teledentistry options for Delta Dental members:

  • Virtual Consult is a synchronous service where members can use a smart device to have a live video chat with a Delta Dental dentist.
  • Toothpic is an asynchronous service that allows members to take photos of problem areas and get an assessment from a Delta Dental dentist within 24 hours.

These teledentistry tools allowed Delta Dental members to get expert advice and feedback on their dental needs even when they couldn’t make it into the office.

How people used their benefits

The early stages of the pandemic saw a decline in the number of patients going to the dentist’s office. One of the main reasons for the decline was that the sharp economic shutdown led to over 20 million Americans losing their jobs (PDF) and their dental coverage as well.

This decline had a profound effect on the nation’s oral health. In 2019, the most common procedures according to Delta Dental claims data were either routine preventive care or evaluations for specific issues. This shifted in 2020, when some of the most common procedures were fillings and root planing. 

Instead of staying on top of their dental health with low-cost diagnostic and preventive care, people instead required more expensive procedures to address the effects of dental neglect.

In addition to the economic hardships COVID-19 brought to patients, COVID also increased mental and emotional strain. Since the pandemic began, the number of adults reporting symptoms of anxiety or depressive disorders has risen to over 40% from about 10%.

These symptoms can manifest in jaw clenching and teeth grinding. Based on Delta Dental claims data, the number of patients requiring occlusal guards to prevent damage rose nearly 10% in the second half of 2020 compared to the same period in 2019.

Anxiety and depression can also lead to an unhealthy diet or substance abuse, which can in turn lead to oral health issues such as cavities. This may also help to explain the surge in fillings and scaling and root planing procedures in 2020.

Health and safety in the dental office

Even though COVID-19 is spread by exhaled aerosolized droplets, visits to the dentist’s office proved safer than visiting any other medical professional during the pandemic. 

Nearly 100% of dentist offices rapidly adopted enhanced infection control measures like pre-appointment screenings, in-office air purification and antiviral mouthwashes. 

Once vaccines became available, they saw widespread adoption amongst dentists, even before state and federal mandates. By the second quarter of 2021, over 90% of dentists had received at least one vaccination shot for COVID-19.

Patients also view dentists as valuable sources of information about their overall health in addition to their oral health. Two-thirds of dentists reported receiving questions from patients about the COVID-19 vaccine, according to the ADA (PDF).

Dentists rose to the occasion, with over 80% reported feeling prepared for these discussions and 95% believing it was important to have such discussions with patients. For employees who may be hesitant to get the COVID vaccine, speaking with trusted health professionals like dentists may help persuade them of the efficacy of getting vaccinated.

What did we learn from COVID-19?

Here are three key takeaways for employees and your business as you look to the future.

  • Encourage employees to use their benefits even during times of crisis. During the early stages of the pandemic, going to the dentist for a teeth cleaning was likely far from most people’s minds. Letting oral health slide in the short term can lead to costly and painful issues in the long term. Teledentistry tools can help employees get expert evaluation, even when they can’t make it into the dental office.
  • Let employees know what resources are available to them. Studies have shown that most people don’t really understand how insurance works. Your help as an insurance expert can go a long way towards letting employees know what kind of coverage and resources are available to them. There are plenty of benefits materials available for you to download and share with employees. Additionally, initiatives like Smile On can help employees maintain their coverage even in the face of economic uncertainty.
  • Consider benefits as part of your employees’ total wellness. Dental benefits are essential for helping employees maintain their overall health and wellness. Many ailments have symptoms that manifest in the mouth, including stress and anxiety. Valuable employee benefits can also help ease employees’ stress about staying healthy and paying for care. When your employees know how to make the most of those benefits, they’re more likely to catch and treat minor issues before they become major ones.

The intelligent future of dental insurance

First, let’s set the record straight: Artificial intelligence, or AI, in the dental industry doesn’t mean your dentist will be replaced by a robot. (Although, yes, a robot dentist might be kind of awesome.)

Instead, AI technology will bring the accuracy, consistency and efficiency of the delivery of dental care to a new level. And the good news is that this futuristic technology is here now.

What is artificial intelligence, anyway?

While the technology is complicated, the idea behind it is simple: AI uses computer software to analyze large sets of information and find patterns in them. As it gathers more and more information, it gradually learns to assess situations and then make informed decisions or predict outcomes.

So what does artificial intelligence mean for the dental industry?

When a patient visits the dentist for to receive treatment for a dental issue, two things must occur. First, the dentist must determine the appropriate procedure and submit a claim to the insurance company. Second, the insurance company must determine whether the dentist’s claim is valid and the procedure will be covered.

For both dentists and insurers, inconsistency and disagreements during this process can cause frustration and delays, which can in turn lead to frustration and delays in treatment for your employees.

Here’s how AI can help.

AI can make quick, impartial decisions

In many cases, AI can analyze data far more quickly and accurately than a person can, and can act as a second opinion. One of the most promising applications for AI is analyzing oral imagery, or as they’re more commonly known, x‑rays.

“When dentists make diagnostic decisions, there are clear-cut rules,” said Dr. Daniel Croley, Delta Dental’s chief dental officer. “There are clinical rules that say, ‘This is decay,’ or ‘This is periodontal disease.’ However, that’s also open to some interpretation, and dentists have different levels of aggression when they want to treat disease.”

AI analyzes x‑rays to bring consistency and reliability to decision making, Croley said.

AI can help eliminate fraud

Certainly, most dentists are ethical and want to provide only appropriate treatment for their patients. Still, insurers have to watch out for those few bad actors who abuse the system to help ensure dental care remains safe, effective, available and affordable for your employees.

For questionable claims, insurance companies have teams of dentists available to review claims and the accompanying x‑rays for fraud. But the volume of claims insurers receive (Delta Dental processed more than 34 million claims in 2020), makes manually reviewing every claim for fraud impossible.

AI can help dramatically expand insurers’ ability to detect fraud. By being able to examine and compare thousands of x‑rays, AI can quickly detect abuse such as resubmission fraud, where a dentist uses the same x‑ray to submit multiple claims, and overdiagnosis. (It can also identify honest errors, such as when a dentist mistakenly submits the wrong image.)

Because AI can retain vast amounts of information and compare it instantly, Croley said, it can identify potential fraud much more easily than a person can.

“It will be able to not only to review reports like we do to determine how a certain procedure was done,” Croley said, “but it can also look at the x‑ray that was submitted with it and say, ‘Hey, this was submitted last year for another patient.’ AI will be able to recognize that and learn as it as it goes along.”

It’s for this reason that Croley believes fraud detection is emerging as one of the leading uses for AI in dentistry right now.

This ability to detect fraud quickly and accurately is a win for everyone. It protects insurance companies from dishonest dentists and conversely ensures that ethical dentists are treated fairly by insurers when they submit claims. This trust and efficiency will in turn inspire confidence for your employees.

“We only want to have quality dentists and dentists who deliver quality care in our network,” Croley said. “What AI will help us do is to monitor our network very closely, develop appropriate oversight plans and then take action when necessary. And I think how that manifests for our members is more confidence in the dentists that are endorsed by Delta Dental as network providers.”

The future for AI in dental insurance looks bright

AI is still an emerging and evolving technology, so its full promise hasn’t been realized, and there are still challenges that must be overcome. For instance, many states require a licensed dentist to be involved in any review of a dental claim.

“There’s still a lot of rules around benefit determination at the state level,” Croley said, “but once regulation starts to keep up with the technology, we may see some of that evolve from a regulatory standpoint.”

Still, Croley is optimistic about AI’s potential and what it will mean for your employees. He believes AI will enable Delta Dental to improve the quality of treatment that its dentists deliver and members receive. This in turn will increase members’ confidence in Delta Dental.

“This is what I’m excited about,” Croley said.” People trust us to do the right thing, and AI will enhance the level of trust that they have with us.”

Dental fraud — what it is and how you can help fight it

Fraud accounts for an estimated 3% of the United States’ total spending on health care, according to the National Health Care Anti-Fraud Association. That may sound like a small percentage, but with dental spending in the United States projected to reach almost $200 billion by 2030, that means over $6 billion in dental fraud that year.

Dental fraud is “any crime where an individual receives insurance money for filing a false claim, inflating a claim or billing for services not rendered,” according to the American Dental Association. Fraud can take many forms, but it requires intent, deception and unlawful gain.

Fraud harms your business and your employees. It drives up the cost of coverage for you and your employees in the form of higher premiums. Every year, the average family in the United States spends an extra $400 to $700 on increased premiums because of fraud.

Common signs of fraud to watch out for

Because fraud requires intent and deception, there are signs to watch out for. Encourage employees to check their Explanation of Benefits statements and look out for dental offices that:

  • Submit claims for covered services when non-covered services are provided
  • Recommend unnecessary or expensive services when simple services will suffice (for example, recommending a crown when only a filling is necessary)
  • Report inaccurate treatments to the insurance company (for example, prophylaxis vs. periodontal maintenance)
  • Misrepresent dates of service to the insurance company
  • Fail to disclose insurance coverage to their patients
  • Refer patients to specialists when treatment is not needed

It’s entirely possible for dentists and staff to find themselves on the wrong side of the law after an attempt to help patients who might be seeking help with their coverage. Waiving coinsurance costs is one example of this. In other cases, it might be a simple oversight. Common mistakes considered fraud include:

  • Listing the incorrect treating dentist on a claim
  • Coding the wrong treatment (for example, prophylaxis vs. periodontal maintenance)
  • Altering dates of service

Fraud can also be perpetrated by dentists’ patients. Let employees know that the following actions are considered fraud.

  • Using another person’s ID or multiple IDs to obtain benefits
  • Requesting that dentists misreport dates to circumvent calendar year maximums or limitations
  • Misrepresenting available coverage to dental staff or asking them to misrepresent care to the insurance company (this includes concealing dual coverage)
  • Adding individuals to a policy who are not eligible dependents or family members

Finally, employers can find themselves on the wrong side of fraud law as well. Be sure to avoid:

  • Allowing ineligible people to enroll in coverage
  • Making inaccurate statements that can reduce workers’ compensation premiums. Such statements include misclassifying employees, underreporting employees, underreporting payroll, reporting full employees as independent contractors and misrepresenting the name under which your company does business.

What you can do to help protect yourself and employees

Fraud can happen at any point in the process of providing care, accepting payment and submitting claims. Dental offices with clear, consistently applied policies can help everyone play their part in fighting fraud. Here are some general tips that you can encourage employees to keep in mind as they choose their dentists.

  • Discuss coverage, fees and payment prior to the dentist providing services, especially for optional and non-covered services. This way employees will fully understand what their financial obligations are prior to accepting service.
  • For treatments over $300, request a pre-treatment estimate from dentists. This is a free service available to Delta Dental PPO™ and Delta Dental Premier® members. DeltaCare® USA members should review their benefit booklet for a list of covered services and applicable copayments.
  • Ask dentists if they have written anti-fraud policies and if their office staff has read and signed these policies.

To help your company avoid fraud, you can also:

  • Refer employees to the “Fight Fraud” flyer (PDF) as an educational aid
  • Implement a clearly defined anti-fraud policy and have employees sign it
  • Set up internal controls and segregate duties (for example, ensuring different sets of employees have access to plan assets and records, rather than putting one person in charge of everything)

What Delta Dental does to help prevent fraud

You don’t have to combat fraud on your own. We’re proud to be your partners in working to eliminate fraud at all levels and steps of the dental care process. What we do includes:

  • Educating our clients, members, dentists and employees about fraud detection and prevention
  • Conducting clinical patient examinations to ensure that provided services meet professional standards and were correctly submitted
  • Reviewing financial and treatment records to ensure contracts are followed
  • Reporting potential cases to state and federal law enforcement and cooperate with fraud investigations
  • Pursuing the recovery of funds when fraud is suspected
  • Terminating contracts when fraud is confirmed

If you suspect fraud, report it. Call Delta Dental’s Anti-Fraud Hotline at 800–526-1852. Provide this number to your employees and encourage them to do the same. Callers may remain anonymous if they choose.

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