Benefits administrator blog from Delta Dental

Tag: dentist networks (Page 1 of 2)

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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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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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.

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May the Fourth (of our PPO network) be with you!

On this fourth day of May, we’d like to remind you of the benefits of PPO network utilization — Star Wars style. May the network force be with you (and with your enrollees)!

First, we interviewed Yoda about the benefits of offering a PPO plan. He says, “To offer your enrollees a PPO plan because they have the freedom to choose any dentist, you probably chose. And with a Delta Dental PPO™ plan, offering secondary access with our Delta Dental Premier® network, you are.”

And he’s right — with Delta Dental PPO, more of your enrollees have an opportunity for moderate savings with a Premier dentist. (But they’ll usually save the most if they go PPO, which is why it’s important for enrollees to understand how to use their plan.)

Need some Jedi wisdom on your dental benefits? Here are some answers to common questions and some things for you (and your enrollees) to consider.

Network (and non-network) dentist visits: A battle scenario

Let’s say your enrollees are young Jedis about to battle skilled Sith warriors. In this scenario, the Sith warriors are the out-of-pocket costs of going to the dentist. So, have your enrollees choose a weapon.

  • No weapon means minimal protection — kind of like visiting a non-Delta Dental dentist. Your enrollees aren’t taking advantage of any of the network savings that your carrier is offering.
  • Using a lightsaber is nice, but your enrollees wouldn’t bring a lightsaber to a blaster fight, would they? This is moderate protection — like visiting a Delta Dental Premier dentist.
  • Finally, using a blaster is usually your enrollees’ most reliable form of protection. Like visiting a Delta Dental PPO dentist, they’re getting the most protection against Siths — er, out-of-pocket costs.

“What if my group has a PPO plus Premier plan design?” We thought you might ask. In that scenario, you’re offering your enrollees more protection against balance billing than you would be with a standard PPO plan, but they (and your group’s overall plan costs) will usually benefit most from going PPO.

Dental networks and finding a dentist

A dental plan is only as valuable as its network. That’s why we’re proud to offer expansive, nationwide PPO access. If you think an army of storm troopers is a crowd, you haven’t seen our provider directory.

And your enrollees don’t have to go to Tatooine to find network savings — tell them to log in to our online services and use our Find a Dentist tool to find a PPO dentist near their home, office or any chosen location.

Encouraging PPO utilization 

You should talk with your employees about the benefits of in-network dentist visits, like more potential savings and more convenience with no claims forms.

In Yoda’s words, pass on what you have learned! Consider attaching this instructional flyer (PDF) to your next group email and encourage them to search only for PPO dentists. And remember — the force is strong with those who go PPO.


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