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.
If you’re recommending a carrier who leases its dentist networks, ask these questions to see how it could impact your client.
- 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.
- 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.
- How much of a carrier’s dentist network is leased?
Why it matters: Dentist turnover might be higher if a carrier leases dentists. Why? Because a leased dentist’s network agreement could end before a group’s benefits contract. This means, if a large part of a carrier’s dentist network is leased, there could be a greater chance enrollees will find their dentist is suddenly no longer in network.
- 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, a group may end up with multiple fee schedules, which is known as stacking. This could cause inconsistent costs for the group if different fee schedules are applied across the network. Dentists may also be confused about how to bill enrollees, which could potentially increase claims costs depending on which fee schedule they apply.
- 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.
- 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 the group. If a carrier leases dentist networks to increase their network numbers, groups need to consider how much they’re being charged for access to the additional dentists. These fees may differ between portions of the network.
Have any suggestions, or want to share your progress? Send us a quick email at email@example.com.
Want more benefits solutions, industry news or HR tips and tricks? Subscribe to Insider Update.
If you’re an employer, benefits administrator or HR professional, subscribe to Word of Mouth.