Broker blog from Delta Dental

Tag: Delta Dental PPO (Page 1 of 2)

Take the mystery out of dental expenses with the Cost Estimator

Your group clients’ members are busy enough, so trying to figure out how to budget their dental care shouldn’t become a second job. That’s why we created the Cost Estimator, a tool available for desktop and mobile that members can use to estimate quickly and easily what their next dental visit will cost.

What’s more, the Cost Estimator has just been refreshed with a new, accessible and mobile-optimized design.

How can the Cost Estimator can help members?

The Cost Estimator provides members with a personalized estimate (based on the fee schedule from the last dentist from whom they received service) for an entire dental visit with a specific dentist. It calculates members’ out-of-pocket costs based on their current benefits. Information is updated daily, so members can always count on getting an accurate cost estimate.

This versatile and easy-to-use tool offers members a variety of useful features and information to help them make the most of their benefits and helps them become better informed consumers.

In the tool, clients can choose from a list of common dental procedures ― they can even specify which tooth needs treatment or what type of filling they’d prefer! After they select their procedure, the Cost Estimator calculates their estimated out-of-pocket cost. The tool subtracts both the network savings and the portion the plan pays.

Other tasks your clients can perform with the Cost Estimator include:

  • Adding procedures. If clients need to add services such as a cleaning or x‑rays to their visit, they can add them to their estimate to get the total cost of the visit.
  • Comparing dentists. Clients might be curious to see if they’d save by switching to another dentist. The Cost Estimator lets them compare up to five in-network dentists to find the best deal.
  • Selecting plan members. Clients can get cost estimates for anyone on their plan, such as spouses and children.
  • Reviewing benefits usage. Clients can access the benefits activity and history for everyone on their plan, and can also review their plan’s maximums, deductibles and out-of-pocket limits.

How can the Cost Estimator help my group clients’ bottom line?

The Cost Estimator provides members with transparency about their out-of-pocket costs. More cost transparency can mean fewer questions and less confusion about the value of visiting an in-network dentist. By showing the substantial cost differences between in-network and out-of-network dentist visits, the tool encourages in-network utilization — which can help members save and may help lower group dental plan costs.

Which clients can use the Cost Estimator?

All Delta Dental PPO™ and Delta Dental Premier® groups are eligible to sign up for the Cost Estimator. DeltaCare® USA members receive a plan booklet with their copayments for covered services, so this tool isn’t necessary for DeltaCare USA plans.

If you have group clients that haven’t taken advantage of the Cost Estimator, explain to them the cost-saving benefits of this tool. For details, talk to your Sales representative about how your clients can add this service to their plan.

How do members access Cost Estimator?

To use the Cost Estimator, members simply click Plan ahead for a visit from the member portal. PPO and Premier members can also access a more limited version of the Cost Estimator through the Delta Dental mobile app, which details in- and out-of-network fees.


With the Cost Estimator, your clients can be confident that their members are not only about staying within their budgets, but also that they’re getting the best deal for themselves and their families. Be sure your group clients don’t miss out on this valuable resource.

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 clients 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 clients and their 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 members.

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 clients.

The downside of leased networks

Access fees

While carriers may benefit from access fees, your clients won’t. Carriers who lease networks often pass the cost of access fees on to your self-funded clients by withholding claims savings. These fees can also differ from network to network.

We never charge access fees, so you can be sure your clients 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 your clients choose a carrier, they’re locked in for the term of their plan 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 clients and their 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 clients 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, members may not realize their out-of-pocket costs are higher than expected until claims are processed. And these changes can happen at any time.

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 clients — can count on.

What drives buyers of individual Delta Dental plans?

As you’re probably well aware, attracting new clients and pinpointing their needs can be challenging. To help you, Delta Dental recently explored the characteristics of people who buy individual dental plans.

PPO versus DHMO dental plans: What’s the difference?

A PPO plan, or fee-for-service plan, is a network-based plan in which enrollees can visit any licensed dentist, although they’ll save more by visiting an in-network dentist. These plans usually have annual deductibles and plan maximums.

A DHMO plan is a prepaid dental benefits product in which enrollees usually must visit their selected primary care general dentist to receive benefits. These plans have no annual deductibles or plan maximums — enrollees pay a fixed copayment amount for covered procedures.

Who buys individual dental insurance?

Anyone who has either had an employer-sponsored dental plan or bought an individual dental plan in the past is a potential client. Even clients who currently have individual dental insurance may be willing to change or update their coverage to get better rates or richer benefits.

DHMO buyers are more likely than PPO buyers to be switching from one individual dental plan to another. PPO buyers are usually transitioning to an individual plan from employer-based group dental coverage. Not surprisingly, the most common reason for this is because they retired from a job and lost their coverage.

What are some major drivers for dental insurance buyers?

Clients shopping for individual dental insurance obviously care about their dental health. That’s why for both PPO and DMHO buyers, having coverage for preventive care and being able to maintain the appearance of their teeth are the two most important factors in their decision to buy.

For PPO buyers, key factors include a dentist network that allows them to keep their current dentist. Consider suggesting plans that offer a large dentist network, which increases the likelihood that their dentist participates in the plan. PPO buyers also like to stick with what they know — we find that familiarity with a brand is an important factor in choosing a dental plan.

Among DHMO buyers, cost and value are more important. Key factors for purchase include low out-of-pocket costs, lowest price and the best coverage for the price.

Income may help you determine which products to consider for your clients. For clients with higher incomes, consider PPO plans, because we’ve found that these clients usually want the flexibility to see the dentist of their choice. Brand recognition is also important.

For clients who earn less, a DHMO plan may be a better option. Both cost and the ability to meet dental care needs are important to these clients, so knowing ahead of time how much a procedure will cost — and being able to plan and prioritize care accordingly — could be a plus.

For all clients, consider bundling offerings. Dental insurance buyers may also be interested in medical and vision insurance. However, they tend to be less interested in other types of insurance, such as life, disability, accident or pet insurance.

How do buyers like to shop?

According to a recent survey, the broker channel is a preferred method among American insurance buyers, with 43% selecting a broker or agent as a favorite option. That rate was higher among baby boomer and Generation X buyers, 61% of whom purchased insurance from a broker. Among millennials, 23% said they used an agent or broker to buy insurance.

The most popular shopping method overall was online, and most of the buyers surveyed said they used more than one channel to shop.

Among the most influential factors when shopping were an easy application process, followed by trust in the brand.

Is there anything else about buyers that I should be aware of?

Our research indicates that all buyers have a similar perception about value of dental insurance. They believe that dental insurance saves money on unexpected costs and makes visiting a dentist more affordable. Both direct PPO and DHMO buyers agree — dental insurance is a smart financial choice.

SmileWay Wellness Benefits help your clients’ employees stay healthy

More people are becoming aware of the way that health issues can manifest in the mouth and oral health issues can exacerbate other medical conditions. With serious issues like heart disease being responsible for so many deaths in the U.S., your clients may be interested in learning how good dental health can improve overall health. If your clients’ employees have medical conditions that affect their oral health, SmileWay® Wellness Benefits may be available to help meet their needs.

Who’s eligible for SmileWay Wellness Benefits?

Not everyone is eligible for SmileWay Wellness benefits. To claim these benefits, Delta Dental members must:

  • Have a Delta Dental PPO™ plan
  • Belong to a group that offers SmileWay Wellness Benefits
  • Have chosen to opt in to the program

Additionally, members must have been diagnosed with any of the following to be eligible for expanded coverage:

  • Diabetes
  • Heart disease
  • HIV/AIDS
  • Rheumatoid arthritis
  • Stroke

What are the benefits?

Those whose plans offer SmileWay Wellness Benefits are eligible for these added benefits each calendar or contract year:

  • 100% coverage for one scaling and root planning procedure per quadrant (D4341 or D4342)
  • and 100% coverage for four of the following in any combination:
    • Prophylaxis (D1110 or D1120)
    • Periodontal maintenance procedure (D4910)
    • Scaling in the presence of moderate or severe gingival inflammation (D4346)

If your clients have employees whose medical issues necessitate extra dental care, encourage them to consider adding SmileWay Wellness Benefits to their coverage. These benefits can help keep their employees both smiling and healthy!

Effective discount: Understanding a plan’s true savings

When your group clients 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 speaking with your group clients: Savings is more than PPO discounts. When you consider effective discount, you offer a complete story. One with an ending your clients should like.

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

With a new series of educational videos, it’s easy to help your clients make the most of their plans. Whether your clients offer Delta Dental PPO™, DeltaCare® USA or both, you’ll find useful resources to showcase Delta Dental’s networks and online tools.

Get to know Delta Dental’s online tools

Encourage members to sign up for an online account. This video walks members 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 client’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. This video explains the advantages of this plan and how your clients’ enrollees can find a PPO dentist online.

Want to include the Delta Dental Premier® network to offer a wider selection of dentists? This video introduces both the PPO and Premier networks and explain how to search for both in our dentist directory.

For clients that offer a DeltaCare USA plan, this video covers the basics of this prepaid plan and shows 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 easily

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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