Measuring Dental Networks: Facts You Need to Know

Posted on September 21, 2016 in Dental benefit information

From the size of a dental provider's network to utilization rates to money saved, there are multiple ways to measure the overall value of a provider network. The effective discount – which represents savings on all claims both in and out of the network – encompasses a number of individual measures. It is a good overall measure of the value of a provider network. 

According to a recent independent study1, Delta Dental's PPO℠ Plan delivers the industry's best effective discount — averaging 22.4 percent nationally — resulting in more than $4.5 billion in annual savings compared to a baseline of dentists' average charges established using FAIR Health data.

Not only does Delta Dental's PPO network deliver the best effective discount, but Delta Dental of Illinois also offers several unique network advantages.

Single Source Network Solution

Delta Dental of Illinois offers a single source dentist network solution. This means we contract directly with all of our network dentists and no part of our networks are leased from anyone else. Our Provider Relations staff fosters relationships directly with dentists, which helps us build long-term loyalty and improve our ability to determine set fees. Because Delta Dental of Illinois owns and manages the networks directly, quality assurance programs and credentialing processes are always in place and turnover of dentists remains low. Our specialized expertise and experience establishing payment policies helps us build and maintain our networks with tremendous value for you.

Network Dentist Counts

We take the method of counting dentists in our network seriously. Some dental carriers count an individual dentist twice if he or she splits their hours at two different dental practice locations. Choosing to count one dentist as two if they practice at two different locations is not a fair representation of access. Delta Dental of Illinois always reports unique individual dentists in conjunction with other relevant comparable information to help you make informed decisions about dental carriers and their networks. We regularly validate and update network dentists with a trusted third-party resource to ensure the integrity of our network numbers to give you a fair and accurate assessment of the access to dental care our network provides in our online dentist directory.

Network Utilization

We deliver a high network utilization rate of nearly 85 percent because of our unique dual networks Delta Dental PPO℠ and Delta Dental Premier®. Delta Dental PPO and Delta Dental Premier work together to give Delta Dental of Illinois members the most options to choose a network dentist and take advantage of cost savings. Our network dentist no-balance billing policy protects members because network dentists are prohibited from charging a patient for the difference between a dental practice's standard fee and the Delta Dental of Illinois pre-established network fee.

From size of the network, to utilization rates and money saved, there are multiple ways to measure the overall value of a dentist network. Delta Dental of Illinois offers you access to one of the largest dentist networks in Illinois and the country, backed by local, single-site service. We own and manage our networks and dentists who join our networks must agree to abide by our processing policies and network contract. This includes a thorough credentialing process to join the network and an ongoing recredentialing process to ensure dentists meet certain requirements. Additionally, our contracts require network dentists to agree to not charge Delta Dental of Illinois members upfront for any services other than any applicable deductibles or coinsurance. Network dentists also warranty many of the procedures performed, including services such as root canals, denture lining/basing, crowns and fillings. In other words, if a Delta Dental of Illinois member has an applicable service that needs to be redone within the specified timeframe, the member is not financially responsible for the re-treatment.

1 Ruark Consulting LLC's 2015 Dental PPO Network Study