Word of Mouth

When it comes to designing your Delta Dental PPO™ plan, it can be difficult to find the balance between what employees want and what’s most cost-effective for your group. You may think that allowing for high out-of-network reimbursement will keep your employees happy. But high out-of-network reimbursement could actually be hurting them in unexpected ways.
 

What is out-of-network utilization?

Out-of-network utilization is when your covered employees visit dentists who aren’t participating in Delta Dental’s networks. With out-of-network visits, your enrolled employees don’t have the protection of Delta Dental's negotiated provider rates and could experience higher out-of-pocket costs. They could also have the added hassle of having to submit their own claims. For an employer, higher out-of-network utilization generally makes plans more expensive.
 

What is out-of-network reimbursement?

Reimbursement is the amount that Delta Dental pays to dentists. Under most PPO plans, Delta Dental PPO dentists are reimbursed at PPO fees, and Delta Dental Premier® dentists are reimbursed at Premier or PPO fees. Reimbursement for non–Delta Dental dentists varies by plan. 
 

How out-of-network reimbursement affects you and your employees 

High reimbursement of out-of-network dentists can raise the premiums and overall cost of your plan, even if most of your enrolled employees stay in network. 

Not only do your employees who go out of network pay more at the time of service, they also could hit their annual plan maximum more quickly. In the long term, a plan with a high rate of out-of-network utilization may also drive up premium costs by increasing claim expenses.

Keep in mind that a plan with a high out-of-network reimbursement rate ultimately pays more for those obtaining care out-of-network, even though employees all pay the same premium. Enrollees who visit higher cost out-of-network providers are being subsidized by those that are staying in-network. Out-of-pocket costs can fluctuate, meaning some employees are paying more for the same procedures and may even reach their annual maximum faster. 
 

How to promote in-network visits

Luckily, there are a few things you can do to help your employees get the care they deserve.
 

Educate your employees on the advantages of staying in network

The easiest way you can help today is by educating your group about the advantages of in-network dentists. Delta Dental has materials about the importance of staying in-network that are ready for you to share with your employees, including flyers and videos:
 

•  Flyer: Go PPO! 6 great reasons to stay in-network
•  Flyer: Elevate your smile: 7 ways to make the most of your dental plan
•  Video: All about the Delta Dental PPO network
•  Video: Get to know the Delta Dental PPO and Delta Dental Premier networks
   

There are also more specific, customizable flyers you can request through your Account Manager or other sales contacts.
 

Create plan incentives for staying in network

To encourage in-network visits long term, work with your Delta Dental Account Manager to build incentives into your plan design that encourage visiting in-network dentists.
 

Reevaluate your plan’s reimbursement levels

Talk to your Delta Dental Account Manager about updating your plan’s reimbursement levels to encourage employees to choose an in-network dentist. If your plan reimburses non–Delta Dental dentists at a high level, such as the 80th percentile, your Account Manager can help you determine the appropriate level to meet your group’s needs.

By visiting Delta Dental network dentists, your employees receive the predictable, quality care that they deserve. Set up a meeting with your Account Manager today to develop a plan that encourages your employees to choose a network dentist.