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
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.
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 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.