Broker blog from Delta Dental

Tag: dentist networks

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.

What to ask about leased dentist networks

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.

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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.


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5 dentists your clients won’t find in our networks

At Delta Dental, we don’t lease any of our dental networks. In fact, our Professional Relations department specializes in developing close relationships with our providers to ensure quality care for enrollees. This Halloween season, we’re showing you what not to expect in our networks — and that dental visits might not be so scary after all.

Mother and daughter carving pumpkin

Here are some doctors enrollees won’t find in our networks:

  1. Philip Sherman, Finding Nemo

Okay, so P. Sherman might not be your run-of-the-mill villain, but why would anyone want to visit a man who lets his niece torture adorable sea creatures? Plus, enrollees can find a credentialed network provider easier than getting “just keep swimming” stuck in their heads with our Find a Dentist tool.

  1. Stuart Price, The Hangover

While Stu seems like a stand-up guy, enrollees probably don’t want to look up from the chair and see a dentist with a missing tooth, a knot on his head and point-blank taser wounds on his neck. Ouch.

  1. Wilbur Wonka, Charlie and the Chocolate Factory

Unlike Willy Wonka’s father Wilbur, we don’t believe that “lollipops ought to be called cavities on a stick.” While our dentists want patients in great oral health, they don’t use scare tactics to achieve wellness. Instead, our dentists encourage regular preventive care and good oral hygiene to combat plaque and decay. (For wellness tips that your clients can share with enrollees, check out our SmileWay Wellness Program.)

  1. Orin Scrivello, Little Shop of Horrors

Arguably the most evil dentist character ever played, Orin is the exact opposite of what you’ll find in our networks. In fact, we have a whole team of dental consultants on staff dedicated to reviewing claims and preventing fraud, waste and abuse.

  1. Mindbender, G.I. Joe 

There’s no mind bending or brain scrambling here — thanks to our enrollee Online Services! Enrollees can log in at deltadentalins.com to view their benefits, check claims status and even look up average submitted fees for common services with our Fee Finder tool.

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