Benefits administrator blog from Delta Dental

Tag: dentist networks (Page 1 of 2)

Delta Dental’s NCQA Credentialing Accreditation renewed

Delta Dental Insurance Company’s NCQA Credentialing Accreditation has been renewed through March 2024.

“Achieving NCQA Credentialing Accreditation demonstrates that Delta Dental Insurance Company has the systems, process and personnel in place to conduct credentialing in accordance with the strictest quality standards,” said Margaret E. O’Kane, president of the National Committee for Quality Assurance (NCQA).

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA’s Credentialing Accreditation is a quality assessment program that focuses on consumer protection and customer service improvement.

NCQA has reviewed and accredited Delta Dental Insurance Company’s Credentialing functions only. For complete details on the scope of this review, visit www.ncqa.org.

Effective discount: Understanding a plan’s true savings

When you consider a PPO dental plan, certainly one of the deciding factors is savings — during a dental visit, how much will this plan save my employees?

Traditionally, a good way to judge this has been to consider the plan’s PPO network discount, or the discount offered on dental services when visiting a dentist within the plan’s PPO network. After factoring in the fees, the greater the discount, the better the plan, right?

Not exactly. While PPO network discount is one chapter of savings, it’s not the whole story. A more accurate way to gauge a plan’s true savings is to consider the plan’s effective discount. The effective discount considers the average savings enrollees receive when visiting any dentist, either in network or out of network.

It’s here where Delta Dental offers a unique advantage: the Delta Dental PPO™ plan with the Delta Dental Premier® network.

With most PPO plans, the PPO network is absolute — you’re in or you’re out. And if you visit an out-of-network dentist, you’re responsible for the full cost of dental services provided by that dentist. The Premier network offers a secondary network that acts as a “safety net” if a PPO enrollee can’t find, or chooses not to visit, a dentist within the PPO network.

While the Premier network provides a smaller discount than the PPO network, the combined size of the two networks — more than 155,000 unique dentists as of 2020 — ensures that most people covered under a PPO plan can visit a Delta Dental dentist and save. This large network enables Delta Dental to deliver a national network utilization rate of 94%, compared to an average PPO utilization of 65% for competitor networks.

And it’s this safety net that often makes a Delta Dental PPO plan a better value than one from another company.

For example, let’s look at a theoretical example in which there are two group PPO plans with identical fees: one from Delta Dental and one from a carrier without a secondary network. In each scenario, 10 people are insured. Five visit PPO dentists and receive a discount, and five visit non-PPO dentists. The Delta Dental plan provides a 35% discount at PPO dentists. The other plan provides a 36% discount at PPO dentists.

Given the otherwise identical scenarios, it might at first seem that the plan with the higher PPO network discount offers the better value. However, in the Delta Dental plan, four people can visit a Premier dentist for a 19% discount. Because only one person visits a non–Delta Dental dentist, the group receives a total effective discount of 25%. Contrast this with the other plan. Because half receive no discount at all, the effective discount is only 18%.

It’s not surprising then that Delta Dental offers groups the best effective discount in the country, averaging 29.4% nationally in 2019, according to a July 2020 study by Dental Actuarial Analytics. This equals more than $8.2B in savings for enrollees annually when compared to dentists’ average charges for services.

So remember when considering a dental plan for employees, savings is more than PPO discounts. When you consider effective discount, you offer a complete story. With an ending your employees should like.

New videos help explain Delta Dental’s online tools and networks

With a new series of educational videos, it’s easy to help your employees understand their plans. Whether your organization offers Delta Dental PPO™, DeltaCare® USA or both, you’ll find useful resources to explain Delta Dental’s networks and online tools.

Get to know Delta Dental’s online tools

Encourage your employees to sign up for an online account. This video walks employees through the robust online tools Delta Dental offers, including plan details, claim history, personalized cost estimates, the online dentist directory and a wealth of wellness resources.

What if your group’s plan doesn’t include the Cost Estimator? No worries. This shorter version of the same video touches on the same helpful features, minus the personalized cost estimate.

Understand the Delta Dental networks

A PPO plan offers savings, quality assurance and simplicity. Through this video, your employees will learn the advantages of this plan and the steps for finding a PPO dentist online.

Want to expand your employees’ options with the Delta Dental Premier® network? This video introduces both the PPO and Premier networks and explain how to search for both in our dentist directory.

If you offer a DeltaCare USA plan, help your employees understand how this prepaid plan works and show them how to select a primary care dentist.

Ensure accessibility

These videos were designed with accessibility in mind. While the vibrant visuals support the narration, all key messages are conveyed in the audio, which can also be accessed through closed captioning.

Share the videos with your employees

To share these videos on your website or intranet, just click on the videos to navigate to YouTube. Below the video you wish to share, click on Share > Embed. Then copy and paste the code into your webpage or intranet site.

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.

 

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Freedom to choose and other myths about visiting the dentist

3‑minute read

If you’re a benefits administrator, we know you’re pretty busy coordinating a benefits package that best suits your organization’s needs. To save you time answering your enrollees’ biting benefits questions, we’ve got you covered on some popular myths about visiting the dentist.

Health insurance, both medical and dental, can be confusing. Even if enrollees understand plan basics, the details can be tough to understand – and difficult to find. So we’re going to break down three common myths about choosing a dentist, for both Delta Dental PPOTM and DeltaCare® USA plans.

MYTH: Enrollees don’t have much choice, if any, in the dentist they visit.

FACT: Not true. In a PPO plan, enrollees and their dependents can visit any licensed dentist and use their plan benefits. (However, they will usually save more when they visit a Delta Dental PPO dentist.)

For DeltaCare USA enrollees, this is a myth as well. Though our copay plans feature a narrower network of dentists to choose from, enrollees have the option to select a dentist from the DeltaCare USA network. If they don’t make a selection, then we will assign them a network dentist near their home address. Enrollees can also change their selected network dentist, and changes will be effective the following month.

With Delta Dental PPO and DeltaCare USA, your enrollees may have more freedom to choose their dentist than you think.

MYTH: Enrollees must present an ID card when they visit the dentist.

FACT: Regardless of plan type, this is not a requirement. Enrollees can simply provide the dentist with their name, date of birth and social security number or enrollee ID to verify coverage. Or they can display ID cards from their mobile device by logging in to Online Services on deltadentalins.com.

We could all benefit from going green, so encourage enrollees to take their ID cards on the go.

MYTH: Enrollees need to submit claim forms for each dentist visit.

FACT: Convenience is a major advantage of visiting a network dentist. For our PPO and copay plans, enrollees do not need to file claims when they visit a dentist in their network for routine dental care. Enrollees simply visit their dentist, pay their set copayment or share of coinsurance and leave with a healthier smile.

Claim forms may apply for out-of-network, specialty and emergency care, or to get a pre-treatment estimate.

For a quick guide to answering enrollees’ benefit questions, check out our resources for benefits administrators online.

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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.


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