As a dentist, you’re always keeping your ear to the ground for the latest industry news and trends. A popular topic lately is dentists who don’t recommend participating in dental insurance networks - meaning they wouldn’t accept Dental HMO (DHMO) or in-network Dental PPO (DPPO) benefits. The mindset for not participating in these networks has gained traction in the dental community with the recent increase in holistic dentistry practices. Per the Holistic Dental Association’s (HDA) website, around 30% of their registered dentists who disclosed don’t accept dental insurance. Whether you are a holistic dentist or not, this statistic shows that some dentists feel disconnected from traditional insurance provider networks. So, what exactly is the value of being a part of an insurance network? Here are a few of the benefits, and why you should be a part of a dental insurance network.
Dental Benefits are on the Rise
According to the National Association for Dental Plans, there was a 41% increase in the amount of Americans with dental benefits from 2010 to 2016, with over 249 million Americans (or 77%) covered by dental insurance in 2016. The overall trend is that the number of Americans offered dental insurance as a workplace benefit is continuing to grow. And as more people get benefits, they will want to go to dental offices where they can use them. Now, more than ever, not participating in dental insurance networks will cost dentists their patients.
DHMOs are back – with a Twist
DHMO benefits have been seeing an increase in popularity since 2009 and they don’t appear to be slowing down anytime soon. This renewed interest in low-premium plans, coupled with innovative new DHMO offerings such as open access and fee-for-service networks, means that DHMOs are here to stay, and that finding in-network providers is still important to consumers across the country.
Why Not Dental PPO (DPPO)?
One of the most common reasons dentists don’t feel the need to participate in a dental insurance network is that 70% of dental plans are PPOs. DPPO plans offer out-of-network benefits, meaning patients covered by these plans are covered even if the dentist isn’t contracted with the carrier. This can seem like it might be a good deal for the dentist since their patients are covered and they don’t have to participate in the network. But there are two problems here, noted in Authority Dental’s article on DPPOs:
The first is that DPPO plans encourage members to stay in-network.
A lot of plans use a different compensation models for in-network or out-of-network coverage – MAC and UCR are the most common. This means that out-of-network coverage is often significantly less than if the patient stays in-network. This information is made available to patients through their schedule of benefits, online education resources, and explained during enrollment meetings. This leads patients to prefer going to in-network providers so they can make the most out of their benefits.
The second problem is balance billing.
DPPO coverage is a set amount per procedure. If you charge more than what an insurance company views as standard for a procedure, your patient will be responsible for paying the balance. This is known as balance billing and it can cause a lot of frustration for your patients. Providers might not be aware of what each of their patients’ insurance company pays – and if a provider charges significantly more than that, it can lead to a large out-of-pocket cost a patient wasn’t expecting. This can turn patients away and drive them back to in-network providers, where they pay a fixed percent of the cost.
These problems mean that providers who are limiting themselves to patients who have coverage through out-of-network DPPO benefits, are missing out on patients that want to get the most out of the dental insurance carrier’s network.
At the end of the day, dentists choose to be a part of dental insurance networks because they bring in new patients and they make care more affordable. To learn more about the benefits of participating in dental insurance networks, check out our blog on the benefits of accepting insurance.
 Per HDA’s International Directory on 11/12/2019.