Benefits administrator blog from Delta Dental

Category: Industry and policy (Page 2 of 2)

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

How dentists fight opioid addiction

There’s no shortage of issues confronting the country and the world today. Alongside COVID-19 and climate change, the opioid epidemic remains a major issue in the United States. Fortunately, there are steps that dentists can take to do their part to help combat addiction and abuse.

One of the simplest but most effective steps dentists can take involves prescribing alternatives to narcotics. Studies have found that a combination of ibuprofen and acetaminophen can be a more effective pain management tool than simply prescribing opioids.

As Dr. Daniel Croley, our Vice President of Network Development, says, “We ask that all dentists consider non-addictive pain management as their first choice. When narcotics are needed, only prescribe the lowest dosage and quantity needed to effectively manage your patients’ pain.”

In honor of National Recovery Month, Delta Dental has launched an informational campaign to encourage dentists to educate themselves and their staff about the opioid epidemic. This includes letters sent directly to dentists, educational blog posts on the topic and new opioid-focused material in webinars.

We also encourage dentists to:

  • Stay on top of the latest developments in pain management
  • Talk openly and honestly with patients about their history before prescribing opioids
  • Follow ADA guidelines, which include education about opioids, limits on prescriptions, and drug monitoring

In the words of Dr. Croley, “Together, we can stop the overprescription and abuse of opioids.”

What to ask about leased dentist networks

3‑minute read

Cars, houses, clothing, even dogs — the list of items Americans lease today continues to grow. The world of dental benefits is no exception to the trend. Oftentimes, to expand network size, a dental carrier will lease a dentist network from a third party (either another carrier or a company that aggregates dental networks). While the potential for more dentist access is tempting, it’s important to know if a leased network can truly deliver more value to your group.

If your carrier leases its dentist networks, or you’re considering a carrier who does, ask these questions to see how it could impact your group.


  1. Who holds the contract with the leased network dentist? The primary carrier or a third party?

Why it matters: In many cases, when a carrier leases a dentist network, there is no direct contract or relationship with the leased dentists. This may create difficulties in resolving disputes through a third party, which could mean unhappy enrollees. It may also cause confusion about which claims guidelines and processing policies apply. This could leave enrollees waiting longer for a claim to process or even cause an enrollee to be billed incorrectly.

  1. Are leased network dentists held to the same credentialing and quality standards as non-leased dentists? Are they continually monitored by the primary carrier?

Why it matters: When portions of a dentist network are leased, there’s a possibility that their equipment, office cleanliness, treatment plans, safety measures and/or patient history have not been vetted as thoroughly as a carrier’s direct-contracted dentists. Furthermore, if the primary carrier is not involved in monitoring the leased network dentists, there may be no guarantee that these dentists are re-credentialed every three years or that they are credentialed to National Committee for Quality Assurance (NCQA) criteria.

  1. How much of a carrier’s dentist network is leased?

Why it matters: Dentist turnover might be higher if your carrier leases dentists. Why? Because a leased dentist’s network agreement could end before your benefits contract. This means, if a large part of a carrier’s dentist network is leased, there could be a greater chance your enrollees will find their dentist is suddenly no longer in network.

  1. Which fee schedule takes precedence when an enrollee visits a leased network dentist?

Why it matters: When a carrier leases a dental network from multiple companies or carriers, the same dentist could end up in more than one leased portion of the network. If this is the case, your group may end up with multiple fee schedules, which is known as stacking. This could cause inconsistent costs for your group if different fee schedules are applied across the network. Dentists may also be confused about how to bill your enrollee, which could potentially increase claims costs depending on which fee schedule they apply.

  1. How does the carrier ensure the accuracy of its leased dentist directory?

Why it matters: If a carrier does not hold a direct contract with its leased network dentists, it may be hard to ensure the accuracy of the dentist directory. This could create an unpleasant surprise for an enrollee if they’re billed for an out-of-network visit when they thought the dentist was in network. It could also lead to overstatement of network size.

  1. How much is the network access fee when an enrollee visits a leased network dentist?

Why it matters: A bigger network does not always mean bigger savings for your group. If a carrier leases dentist networks to increase their network numbers, you need to consider how much you’re being charged for access to the additional dentists. These fees may differ between portions of the network.


For more helpful tips about dentist networks, be sure to check out our blog articles on network quality and network size.


For more news and dental insights for benefits administrators, human resources professionals and businesses, subscribe to Word of Mouth.

Are you a broker, agent or consultant? Subscribe to Insider Update, our newsletter for benefits producers.

Dentistry’s role in the U.S. opioid epidemic

If you’re reading this, chances are you’re well aware that Americans are struggling with the effects of a nationwide opioid epidemic. In fact, as of 2017, the Centers for Disease Control and Prevention (CDC) estimated that, on average, 115 Americans die every day from an opioid overdose.

But if you’re not following the storyline closely, you may not be aware of some of the risks. Here are some steps organizations, businesses and providers are taking to combat the epidemic.

Recognizing the issue and identifying risk factors

In the face of the epidemic, one of the first responses is both natural and logical — how and why is this happening? Unfortunately, dentists have been linked to the epidemic as a major prescriber of opioids for people ages 10 to 19. (This is typically when people have their wisdom teeth removed.)

Research shows that first-time opioid users show an alarming probability for continuing use. One study revealed that patients in this population who were prescribed a 12-day supply of opioids face a 25% probability of continuing use a year later.

Therefore, it’s crucial to monitor and carefully consider patients’ exposure to these drugs to prevent illicit use. We recognize that dentists, in particular, are faced with the dilemma of treating pain effectively and responsibly. And sometimes the methodology isn’t so clear.

A breakthrough in pain management research

Fortunately, research has shown that opioids are not the only effective course of treating post-operative (and non-surgical) dental pain. In fact, opioids may not even be the most effective treatment in these cases.

A 2018 study published in the Journal of the American Dental Association revealed two crucial things about treating severe dental pain:

  • Combinations of ibuprofen and acetaminophen had the highest proportion of adult patients who experienced maximum pain relief
  • Treatments that included opioids were among those associated most frequently with severe adverse events in both children and adults

With this knowledge, prescribers are better suited to determine and follow guidelines when treating patients with severe pain.

What we’re doing at Delta Dental to combat addiction 

The Delta Dental Plans Association has stated our national system’s position on opioid prescriptions as follows:

Although Delta Dental does not cover prescriptions, including opioids, we are maximizing our unique role of having 75 percent of the nation’s  dentists in our provider network to be an actively engaged voice and  partner in the fight against opioid misuse.

Within our Delta Dental enterprise, we’re engaging our providers, clients and enrollees by sharing resources and continuing a dialogue of awareness and prevention.

We urge our providers to follow best practices in treating acute pain, including:

  • Considering alternative treatments to opioids, like nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen or a combination of these drugs when possible.
  • Conducting a thorough medical and dental history when considering prescribing opioids.
  • Considering treatment options that prevent exacerbation of, or relapse of, opioid misuse.
  • Following CDC guidelines for dosage and duration of prescriptions, including prescribing the lowest possible effective dosage and staring with immediate-release opioids instead of extended-release/long-acting opioids.

For our clients and enrollees, we provide several wellness resources in the oral health section of our website, including a guide for parents of teens who could be prescribed pain medication.

Steps employer groups can take to make an impact

If you’re looking for ways to engage your workforce about responsible opioid use, there are a number of things you can do. And as if you need any further incentive to take action, the Kaiser Family Foundation recently revealed that from 2004 to 2016, employers are spending nearly nine times more to treat opioid addiction and overdoses.

Deloitte’s Center for Health Solutions covers this rise in health care costs in a recent article, and suggests the following steps to take action:

  • Creating drug-free workplace policies
  • Increasing communication
  • Identifying at-risk employees
  • Covering treatment therapy
  • Treating workers for addiction, rather than terminating them
  • Working with health plans and pharmacy benefit managers (PBMs) to find solutions

For inspiration, check out how the Boeing Company took a proactive approach to combating addiction — including mailing letters to patients and prescribing physicians making them aware of the potential risks involved with the drugs.

For more news and dental insights for benefits administrators, human resources professionals and businesses, subscribe to Word of Mouth.

Are you a broker, agent or consultant? Subscribe to Insider Update, our newsletter for benefits producers.


Everyone wants (but doesn’t use) this employer-sponsored benefit

2‑minute read

When people search for jobs on LinkedIn, Glassdoor, Indeed, etc., they surely expect to find a section of each job ad that includes a brief description of benefits and perks. Some company benefits are traditional while others get creative. And a few things are usually constant – paid time off, 401(k) options and health insurance – both medical and dental.

It’s no industry secret that enrollees expect dental coverage in their benefits package. In fact, 88% of job seekers say they would give better benefits some, or heavy consideration when choosing between employers, even if the pay were lower.

So we know that people want — and even expect — dental coverage from their employers and organizations; however, the fascinating thing is that enrollees often don’t use this must-have benefit.

Using claims data* from our enterprise, we found that only 37.2% of enrollees received the recommended two annual cleanings in 2017. And 23.9% of enrollees received only one cleaning. If you’re a current Delta Dental client, or work in the benefits industry in general, does it surprise you that nearly 40% of enrollees didn’t visit the dentist?

Since routine preventive dental care can detect health problems early, and help to prevent more costly medical expenses down the road, it’s concerning that more people aren’t seeking preventive care more often. To curb this trend, consider encouraging enrollees to visit the dentist for their recommended diagnostic and preventive care.

Share the wellness benefits of exams and cleanings with them. We recommend content from the preventive care section of our SmileWay® Oral Health library.

Do you know people who are anxious about visiting the dentist? Check out our tips for easing these fears. As a bonus, watch the magic of dentistry at work — proof that visiting the dentist can even be fun. 

Want more benefits solutions, industry news or HR tips and tricks? Subscribe to Word of Mouth.

If you’re a broker, consultant, or other benefits producer, subscribe to Insider Update.


* Data is based on submitted claims for commercial Delta Dental PPO enrollees, excluding state or federal exchange enrollment. Cleanings are based on claims including the following procedure codes: D1110, D1120 and D4910.

How to give your dentist network a checkup

2‑minute read

You may have read in last month’s network numbers article that network size matters. However, size is just one piece of the puzzle when it comes to determining network value. It’s also important to know how dentists are recruited and trained — and to take a look at the entire experience enrollees have when they visit a dentist’s office. Here are some things to consider when evaluating a dentist network.

The right dentists in the right places

How valuable is a large dentist network if there aren’t any providers near where your enrollees live and work? Not very. Building a strong network is more than a numbers game — it’s about ensuring that your enrollees have easy access to great providers, both general dentists and specialists.

Look for a carrier with a strong recruitment presence near your group. Even if there isn’t a strong dentist network there now, carriers with a solid recruitment team can work with you to build the dentist network your group deserves. Are there particular dentists your enrollees want to visit, but they’re not in network? Some carriers will actively recruit the specific dentists your group wants.

Check out Delta Dental’s dentists in your area, now with Yelp reviews!

Face-to-face training and provider management

While dentist recruitment is important, it’s crucial to work with a carrier who ensures that the quality of care your enrollees receive remains top notch. One good way to gauge this is to find out if your carrier has staff dedicated to working in the field, or if network management is handled remotely. With boots on the ground, network providers can receive thorough in-person training. Plus, your carrier can easily stop by providers’ offices to get a firsthand experience of the level of care provided.

It’s also wise to ask your current or future carrier how it defines a quality dental experience.

  • Are only dentists evaluated, or does the carrier also assess the performance of dental hygienists and assistants?
  • Is the appearance and cleanliness of the dental office taken into consideration?
  • Does the carrier prioritize a smooth appointment check in and payment process for enrollees?

Want to learn how our networks can provide a seamless solution for your group? Talk to your Delta Dental sales rep today! And stay tuned for the next part of this network series, which will highlight the impact leased networks can have on your group.

For more news and dental insights, subscribe to our email list for benefits administrators, human resources professionals and businesses.

Are you a broker, agent or consultant? Subscribe to Insider Update, our newsletter for benefits producers.

Do your network numbers add up?

1‑minute read

Ever wonder how a carrier determines its network size? Good! Some carriers may calculate the number differently, so it’s important to ask how it’s done. These tips can help you get an accurate indicator of your enrollees’ ability to find in-network care.

Find out who (or what) is being counted.

  • Some network counts include projected dentists not yet contracted — they may also include inactive or non-practicing dentists.
  • Rather than counting dentists, some network counts refer to access points. This means the same dentist could be counted multiple times. In large chains, dentists could be counted in every clinic, even if they don’t practice at all locations.

To get a true measure of dentist access, use these guidelines when you request network counts.

With Delta Dental, you know you’re getting a clear network picture — we only count active individual dentists or locations. Want to know more? Call your Delta Dental sales rep to learn more about network value.

For more industry insights like this be sure to subscribe to Word of Mouthour newsletter for benefits decision makers, administrators or HR professionals. 

Are you a broker, consultant or agent? Subscribe to Insider Update, our producer newsletter.

Newer posts »

© 2021 Word of Mouth

Theme by Anders NorenUp ↑