Dental Savings Can Add Up When Employees Use Network Providers

Producers seeking ways to help their clients save money on their benefits costs may find a good source of savings in dental plans.

Specifically, when employees use providers within a dental plan’s network, employers can see significant savings on their dental premiums.

Costs are lower to employers when network providers are used because carriers are required to pay out less in claims costs due to discounts negotiated with the provider. These savings can translate into reductions in premiums at renewal time, sometimes determining whether an employer can fully or partially afford to pay for dental benefits for their employees or keep the benefit at all.

A desirable benefit

Though dental premiums are much lower than full medical plans, dental savings can add up quickly. Dental insurance consistently ranks among the top benefits in terms of participation. In LIMRA’s 2010 survey of employee perspectives on benefits, dental insurance ranked second– behind medical/health, and ahead of vision, life, disability, long-term care and other types of insurance products– when employees were asked whether they participated in an employer-offered plan.

Why would employees choose to use providers who are not part of a dental network? There may be an issue of convenience, they may already have a relationship with someone they trust or they may simply be unaware of the savings and other benefits of using network providers.

Carriers can often work with producers and their clients to communicate the benefits of using network providers, such as:

• There is usually no out-of-pocket payment for preventive services such as exams and cleanings, so members can maintain good oral health at no cost. Many studies have suggested that practicing good oral health is important not only in the early detection of oral cancer, but also of more serious health conditions like diabetes and strokes.
• Procedures such as crowns and dentures can be quite costly, so people often put off or forego these services. Using a network dentist who has agreed to provide these services at reduced charges will act as an incentive for people to obtain these important procedures.
• Providers in many dental networks will also apply a discount to services that are not covered under a plan’s policy, as well as to services performed after a patient’s annual maximum benefits have been exhausted.
• Many carriers offer incentive PPO plans with features such as a higher annual maximums, deductible waived for in-network preventive care or rollover credit when a network provider is used.
• Carriers make it easy to find a credentialed provider. Most provide a website with a provider look-up function, or they have a customer service telephone number that members can call to find participating dentists.
• If members are reluctant to leave their non-network dentist out of loyalty or preference, most networks allow them to nominate their dentist to join the network through nomination forms on websites or by calling the customer service number. Providers are usually more willing to participate if they are requested to do so by an existing patient.

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Promoting network dentists

Though the decision to use a network provider is ultimately up to the employee, the quality of a dental network and the quality of the carrier’s services may be factors in whether employees choose to stay in-network. To that end, producers can help employers sift through carrier offerings, looking for the greatest opportunities to encourage employee use of network providers. Here are some criteria to consider:

• Does the network provide broad access to care, and is there adequate coverage of all specialties?
• Are dentists geographically available and accessible to employees’ home and work locations?
• Is there a mechanism for employees to easily locate a network provider or a list of network providers?
• Is there an easy method of nominating a favorite provider?
• Does the carrier have processes in place to handle a member’s quality-of-care complaint?
• What level of fee discounts are available? Do they apply to all procedures and all specialties? Do they apply after the annual maximum has been met and for procedures not covered by the plan?
• Is the carrier willing to provide discounted fees for a sampling of procedures in areas specified by the employer?
• Will the carrier provide actual examples of out-of-pocket savings to employees based on procedure codes and geographical areas?

With employees increasingly paying more toward their dental benefits, maximizing their out-of-pocket savings can make the difference in whether they choose to participate in a dental benefit plan.

With the proper communication and cooperation between a carrier, broker, employer and employee, dental savings can add up.

Sadia Zoppi is Dental and Vision Product Manager with American General Benefit Solutions (Benefit Solutions), a business unit of American General Life Companies.