Benefits administrator blog from Delta Dental

Tag: dentist networks (Page 1 of 3)

Dual choice: the best of both worlds

None of your company’s employees are quite the same. Some are young and single, some have partners and families, some are approaching retirement. Some have excellent dental health and some, well, don’t. With so many different situations and stages of life, you might ask yourself if a single dental plan can truly meet all their needs.

Fortunately, you have a choice. More precisely, a dual choice ― Delta Dental’s dual choice. This plan configuration allows you to offer the attractive benefits, large network and substantial discounts of a Delta Dental PPO™ plan while also offering the predictability, affordability and simplicity of a DeltaCare® USA HMO-type plan.

How does it work?

As the name suggests, when an employer offers dual choice, employees have the freedom to select between either a PPO or HMO-type plan. With this flexibility, employees can decide for themselves which plan is the best fit, and can switch from one plan to another during open enrollment if they change their mind.

I’m still not sure my employees really need more than one plan type. What are some other factors to consider?

Here are a few reasons your employees might prefer one plan to the other.

 Delta Dental PPODeltaCare USA
AvailabilityDelta Dental’s expansive dentist network combined with the freedom to see any dentist means that employees who select a Delta Dental PPO plan will be able to find a dentist wherever they are, and almost always be able to find one who’s in network.Employees who chose a DeltaCare USA plan must visit their selected primary care dentist. For employees who live in rural or remote areas, being required to stay in the DeltaCare USA network could make finding an in-network dentist difficult.
Choice of dentistsEmployees who choose a Delta Dental PPO plan can see any licensed dentist, which might be important to employees who don’t want to switch from a favorite dentist.DeltaCare USA members must select a primary care dentist from the network. 
ConvenienceA Delta Dental PPO plan allows employees to visit any licensed dentist, regardless of network.DeltaCare USA members must visit their selected dentist, which means that employees may have to schedule time off and drive a significant distance if their dentist isn’t located close to where they’re working.
CostFor employees who need costly dental work, the substantial network discounts on services a PPO plan offers might make the additional expense worth it. For employees, DeltaCare USA plans are usually significantly less expensive than Delta Dental PPO plans. Orthodontics is always covered and often cheaper under DeltaCare USA, which is a plus for families with teens or preteens. These plans also have no maximums.
OrthodonticsNot all PPO plans cover orthodontics, and all have a lifetime orthodontic maximum. All DeltaCare USA plans cover orthodontic treatment. Treatment is covered at a set copayment for children and adults, with no deductibles, maximums or lifetime maximums. These plans also have no limits on the number of courses treatment that a member can have. So if an employee who has already had a full course of orthodontic treatment needs another, the plan will cover the second treatment.
Pediatric dentistryChildren who are covered under Delta Dental PPO plans can visit any pediatric dentist, and there’s no age limit beyond the cutoff set by the pediatric dentist. DeltaCare USA members can’t choose a pediatric dentist as a primary care dentist. Under these plans, pediatric dentists are considered specialists who must be referred by their selected dentist, like with any other specialty care. Pediatric care is also covered only up to age 8; after that, the child must visit a DeltaCare USA general dentist.
SimplicityDelta Dental PPO plans have deductibles and annual maximums. Some services may also have lifetime maximums. Out-of-pocket costs may vary depending whether the dentist is in network.DeltaCare USA plans have no deductibles or maximums. They also provide employees with a list of included procedures and their copayments, so they’ll know exactly what their out-of-pocket costs will be. This makes planning and budgeting treatment easy.

OK, but will offering a dual choice plan create a lot of paperwork and headaches for me?

Relax ― administration is painless!

For more information about dual choice, contact your account manager. To help your employees learn more about dual choice, here’s a useful flyer you can share and a pair of videos that explain each type of plan. You can also refer employees to this helpful site for more information about their plans.

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.

How Delta Dental networks ensure quality care

With Delta Dental, your employees can rely on comprehensive, high-quality oral health care. Why? One of the reasons is that we’ve built the largest dentist network in the country to ensure that your employees can always find a quality dentist they trust while enjoying substantial in-network savings. But that’s not the only advantage our network offers your employees.

Objective ratings help your employees select a dentist

For employees to take full advantage of their dental benefits, they need to feel confident in choosing a dentist who meets their unique needs. To help, we’ve tried to take the guesswork out of finding great dental care.

That’s why our online dentist directory features quality ratings for Delta Dental PPO™, Delta Dental Premier® and select DeltaCare® USA dentists within our 15 enterprise states and the District of Columbia. Developed by a neutral third party, DentaQual ratings evaluate dentists on these criteria:

  • Procedure success rate measures treatment success rate, including the likelihood of repeat procedures and post-treatment problems.
  • Commitment to best practices evaluates how well a dentist follows established standards and treatment methods.
  • Value compares the type and number of prescribed treatments and the average cost per patient.
  • Patient retention compares the degree of patient retention and loyalty.
  • Treatment recommendations compares how a dentist recommends treatment in comparison to dentists in their geographic area and specialty.

DentaQual compares each dentist’s scores to the average scores of their peers to generate an overall rating. And DentaQual automatically refreshes scores each month, so your employees will know that their dentist’s rating is always current.

Member input makes our network stronger

Our members’ opinions matter to us. That’s why we pair DentaQual ratings with Yelp ratings from actual patients to give members an extra level of confidence when choosing a dentist. We even ask our members to recommend great dentists who aren’t in our network so that we can ask them to join. 

Member satisfaction was our main objective in creating our network. In fact, in 2020, 98% of our members said they were satisfied with their dentist and the quality of the care they received.

A proprietary dentist networks offers your employees unique advantages

Unlike some other carriers who lease their networks, we’ve built our own. Of course, you might ask yourself why the network matters as long as your employees have access to dental care. It’s because your employees will enjoy several distinct advantages with Delta Dental’s networks versus a leased network:

  • Quality. We have direct contracts and relationships with our dentists and hold each to consistently high standards. In a leased network, carriers may not have a relationship with dentists, and dentist credentialing may be inconsistent.
  • Size. You can count on our network size to be accurate ― we update our directory daily ― and since we have relationships with our dentists, turnover is low. Carriers with leased networks may not know exactly how many dentists their networks contain, and if the carrier’s network lease ends before your contract does, some of your employees could find themselves without an in-network dentist.
  • Value. Our networks offer predictable, consistent fees. Leased networks may not be able to make that promise. And we never charge for network access, unlike some carriers with leased networks that withhold claims saving to cover access fees.

The largest network in the nation means your employees save

A large network means it’s easy for your employees to stay in network, which translates to lower costs. And when it comes to a large network, we lead the competition. Our Delta Dental Premier network is the largest in the nation, based on total unique dentists, according to Zelis Network360’s September 2021 report.

Why is counting unique dentists important? Because it sets us apart from carriers that count access points instead. Access points represent the number of network dentists at each dental office where patients are treated. This means a single dentist who treats patients at several offices could be counted multiple times, which may not represent the actual number of individual dentists in the network.

With Delta Dental, you can rest assured that your employees will receive quality care. Delta Dental’s robust, nationwide networks offer quality assurance, savings, simplicity and choice.

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.

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