How to evaluate dental networks

The decision to join a dental network can be significant for your dental practice. Dental networks can increase patient flow and stabilize income, but not every network will be the right fit for your practice. If you're looking for a dental network that aligns with your business goals and patient care standards, here are important factors to consider:

• Different types of dental networks

• Specific ways joining a network can improve your business

• How to evaluate and choose among several options

• The importance of technological fit

Understanding dental networks

The type of network you choose to join may impact your reimbursement rates, patient volume, administrative burden, and many other aspects of your practice. The main network types for dentists are preferred provider organizations (Dental PPOs) and health maintenance organizations (Dental HMOs). Note that providers who don’t join an insurance network may still see some patients with insurance under the fee-for-service model.

PPO networks

In a Dental PPO (or DPPO), you contract with an insurance network as a preferred provider, offering a discounted fee schedule for network patients. In return, you get first access to a large pool of dental patients, because people with PPO dental insurance tend to seek out in-network dentists for greater convenience and lower cost.

Pros:

• Enhanced marketing support

• Greater patient volume

• More stable revenue stream

• Greater convenience for patients, because you process their claims

• Flexibility to accept out-of-network patients

Cons:

• Discounted fees and reimbursement

• Additional claims administration

• Network documentation requirements

HMO networks

Dental HMO patients choose a primary care dentist from the network, which pays a set fee to participating dentists for each patient, whether a patient seeks services or not. There are no out-of-network benefits, but patients are encouraged to have preventative dental care with checkups and regular cleanings at no cost. Other covered services and treatments typically have set co-payments, and overall dental health out-of-pocket costs are usually lower with a DHMO than a DPPO.

Pros:

• Predictable revenue

• Guaranteed patient base

• Lower marketing expenses

• Simplified billing and fee structures

Cons:

• Lower reimbursement rates per procedure

• Must maintain specific patient-provider ratios

• Increased compliance and protocol requirements

Fee-for-service

Many dental insurance plans provide out-of-network benefits, allowing prospective patients to see any dental provider, even if they are not part of the dental network. Under this model, the out-of-network dentist bills patients directly at their quoted rate; the patient then submits the bill to their insurance, which pays a portion of covered costs. Since they aren’t part of a network, these providers have greater autonomy to set rates and determine treatment plans.

Pros:

• More control over fees

• Potentially lower administrative overhead

• No network restrictions on procedures, labs, or materials

Cons:

• Costlier patient acquisition

• Unpredictable volume and revenue

• A less-appealing choice to insured patients

How joining a dental network can help grow your practice

Joining a dental network can help boost patient referrals, stabilize your revenue, and lead to several advantages for your practice.

Serve more patients

A dental network can direct a reliable stream of patients to your practice, allowing you to help more people enjoy the benefits of good oral health.

Enjoy steady revenue

Enhanced referrals and marketing support can help expand your patient base, reduce the unpredictability of fluctuating revenue and offset changes to reimbursement rates.

Simplify the claims process

Choosing a network provider with dental plans that streamline claims and offer comprehensive administrative support can help benefit you and your patients.

Improve the patient experience

More cost-conscious patients can take advantage of the savings offered by using an in-network provider.

How to Evaluate Network Options

Joining a dental network is a significant business decision as well as an opportunity for growth. To choose the right network for your dental practice, you’ll want to consider a range of factors that could affect your experience. Here are some of the most important considerations to keep in mind.

Network strength

A primary concern should be the network's strength, stability, and characteristics. Is it worth being part of their provider directory? What are the demographics of the patient base, and is there market opportunity? What employer groups participate, and how many new patients can you expect? How long has the network been in operation, and what is the provider turnover like? How does the insurance company communicate with its members, and what actions does it take to drive members to network dentists?

Reimbursement rates

Compare the network’s reimbursement rates to your existing fee schedule. It’s common to see a difference between the two, keeping in mind that the increased volume of patients may well be more than enough to offset a change in reimbursement. To be sure it makes economic sense for your practice, run a financial analysis comparing your options.

Contract terms

Contract terms and conditions can have an outsized impact on your bottom line. Carefully examine any exclusivity commitments, patient acceptance requirements, and evaluation criteria and performance metrics. Are there office hour requirements, or after-hours and emergency care expectations? Make sure your practice can handle the terms of the agreement.

Administrative efficiency

Ideally, a dental network will have an efficient system for administration, including payment processing, claims handling, eligibility verification and other considerations faced by a dentist's office. Check what pre-authorization requirements there are and an established appeals policy and recoupment process.

Provider satisfaction ratings

How do current providers rate the network? Are there opportunities for continuing education or strategic partnerships that can support your practice? High satisfaction ratings are a good sign of a beneficial partnership.

Patient retention

Examine how satisfied the patients are with their network. Consider patient retention statistics and how the network impacts patient costs and oral health outcomes. Does the network show growth? Networks with strong patient retention are more likely to be worth joining.

Technology integration with a dental network

Seamless technology integration makes joining a dental network relatively easy, while incompatible technologies can cause unnecessary headaches. When evaluating a dental network, make sure you check:

• Electronic health records compatibility

• Online appointment scheduling systems

• Teledentistry integration, if any

• A mobile app that makes it easy to understand their benefits and find a network dentist

This will also provide an opportunity to run some cost-benefit calculations to determine whether the startup effort to join the network will be worth any IT systems adjustments and whether you'll need to make any upgrades to diagnostics and other equipment.

Other considerations

Beyond the quantitative analysis involved in deciding whether your practice should join a dental network, you should also consider how it fits with your goals and vision.

• How might the network affect your practice’s visibility?

• Will it help provide the kind of care you envision for your clients?

• How will you balance network requirements with practice independence?

• Are there options for participating in multiple networks?

• What are the credentialing requirements?

• What legal considerations might affect your decision?

• What will the timeline look like if you join?

• How do other contracted dentists feel about the network?

• What is the opportunity cost of joining vs. declining?

• What resources will you need to be successful?

Making the final decision

Consider using a framework to evaluate your options. Create a spreadsheet with the factors reviewed above, and weight each consideration according to your priorities. Consider whether the network will be a strategic fit with your goals for the practice and what metrics you need to track to make an informed decision. Reach out to network representatives for answers to any questions you may have, and seek input from other providers and management professionals. It's also important to get professional advice on the network's terms and conditions; have a trusted attorney review the contract to help ensure it works for you.

Speak to Guardian

Guardian is committed to helping our dental plan enrollees achieve the best possible oral health outcomes while helping our network provider partners meet their professional goals. Contact us to see if we can help serve the needs of your practice.