Delta Dental’s Monopoly and the Rise of Shared Networks: What Office Managers Need to Know
Delta Dental has long held a dominant position in the world of dental insurance. As one of the largest dental insurers in the nation, its influence over dental networks and reimbursement models has shaped much of the industry.
However, in recent years, other insurance companies have started to counter by forming “shared networks,” which are basically collaborative arrangements where multiple insurers utilize the same pool of providers to expand their in-network providers.
Shared Networks and Why They Matter
While shared networks can increase access and flexibility for patients, they also come with complexities. One growing concern is the frequent changes in provider network participation.
In some cases, a dentist may be considered in-network for a patient one day, and out-of-network the next, depending on how insurers shift their relationships within the shared network model. These transitions are not always transparent or timely, leading to confusion and unexpected costs for patients.
Network Instability and Impact on the Practice
Another growing concern for dental practices is the lack of control over network participation.
When doctors agree to join a specific insurance network with the intention of limiting their participation to a small patient base, they are increasingly being added to additional networks without their explicit consent. As a result, long-standing cash-paying patients may suddenly be considered in-network through their insurance plans, leading to reduced reimbursement rates for services that were previously paid in full.
This not only impacts the practice financially, but also undermines the provider’s ability to manage patient relationships and fee structures on their own terms.
How My Office is Responding
At my practice, we understand how important it is for patients to know their benefits before treatment begins, and we strive to provide that for them. We are diligent about verifying insurance eligibility and network status before every appointment. Unfortunately, despite our best efforts, we are not always notified when a provider’s network status changes due to these behind-the-scenes adjustments between insurance carriers.
Additionally, on numerous occasions, we have called an insurance company to inquire as to which network they consider us to be in and are told one thing by the representative, only to discover when the explanation of benefits arrives that it reflects the opposite of what we were told over the phone.
To address this issue, we have taken several proactive steps:
Patient Responsibility
One of the first things we implemented to address this issue was to encourage patients to regularly check with their insurance companies and communicate any updates with us.
As the landscape of dental insurance continues to evolve, clear communication between providers, patients, and insurers is more essential than ever to prevent surprises and ensure everyone receives the care they deserve without unnecessary financial stress.
Document
Another step we began taking was to document every interaction with insurance companies, including the date, time, and name of the representative we spoke with, since these calls are typically recorded. This documentation has helped us resolve discrepancies on multiple occasions.
Submit Pre-Treatment Estimates
Finally, we submit pre-treatment estimates to help set expectations. While there is no guarantee of payment, they provide written documentation of what the insurance carrier anticipates covering.
This shifts accountability away from the dental office and helps patients better understand that their insurance company, not the provider, is ultimately responsible for payment decisions.
Strengthening Patient Trust Amid an Evolving Insurance Landscape
As insurance companies continue to adapt and respond to Delta Dental’s market dominance through shared networks, dental providers and office managers are left to navigate an increasingly complex system. The best defense is a combination of proactive verification, thorough documentation, and open communication with patients.
While we can’t always control sudden network changes, we can equip our patients with the knowledge they need to avoid unexpected costs and reinforce trust through transparency and diligence.
About the Author
Amanda Matthews, MAADOM
Amanda Matthews is a dedicated and experienced dental office manager in Bethesda, MD, where she has been a valued member of the same practice for over 22 years. Passionate about enhancing patients’ lives through smile transformations, she is committed to helping individuals improve their self-confidence and overall well-being.
With expertise in patient relations, billing and insurance processing, and fostering team engagement in charity events, Amanda plays a crucial role in maintaining the smooth operation of the office while ensuring a welcoming and supportive environment for both patients and staff.
