Delta Dental Deep Dive: PPO vs Premier, Negotiations, and Exit Strategies

Delta Dental is simultaneously the most loved and most loathed insurance company in dentistry. It's the largest source of patient volume for many practices—but also the largest source of frustration. This guide provides comprehensive strategies for negotiating with Delta, deciding between PPO and Premier, and successfully resigning when the time is right.

Understanding Delta: Why It's Different From Other PPOs

Delta Dental controls roughly 40% of the dental insurance market—hence the term "the 5,000-pound gorilla." This market dominance means Delta operates differently than smaller plans:

• Limited negotiation leverage: Because so many dentists want to join Delta, they have little incentive to negotiate with individual practices
• Declining fee schedules: Delta has consistently reduced contracted fees over the past decade
• Significant patient base: For many practices, losing Delta means losing a substantial portion of your patient population
• Market power: Delta's actions set the tone for other insurance companies

This combination makes Delta both essential and problematic for most dental practices. You need to understand this dynamic to make strategic decisions about your participation.

Delta PPO vs. Delta Premier: Which Should You Keep?

Understanding the Difference

Delta PPO: This is their standard plan with the lowest contracted fees. It's what most people think of when they think "Delta insurance."

Delta Premier: Historically offered higher reimbursement rates than Delta PPO. Many practices kept Premier longer because the fees were more bearable.

The Reality Check

Today, the fee gap between Premier and PPO has narrowed significantly. In many markets, the difference is minimal—sometimes only 3-5%. Additionally, the gap between Premier fees and true fee-for-service rates remains substantial.

Should You Negotiate With Delta?

The Reality of Delta Negotiations

Negotiation with Delta is theoretically possible but practically difficult. Here's why:

• Delta knows you're unlikely to reject their offer because losing Delta means losing patient volume
• They can point to supply and demand—there are dentists waiting to join their network
• They've consolidated market power to the point where individual practice negotiations carry minimal weight
• Even successful negotiations typically result in minimal fee improvements that don't address the core issue

The Changing Dynamics: Is Delta On the Ropes?

Signs of Leverage Shifting

Interestingly, the dynamics between dental practices and Delta are gradually shifting:

• Employer pressure: Employers purchasing insurance for their employees are increasingly demanding lower premiums, which forces Delta to cut provider fees
• Assignment of benefits changes: Delta has started allowing out-of-network assignment of benefits (previously they didn't), giving practices more flexibility
• Legislative pressure: Some states are implementing regulations that improve the balance between payers and providers
• Dentist movement: More practices are resigning from Delta, creating slight supply pressure (though Delta isn't concerned yet)

While these shifts are happening, they don't yet fundamentally change Delta's negotiating position. They do, however, make it slightly easier for practices to resign by allowing them to collect benefits out-of-network if they choose.

The Resignation Strategy: How to Successfully Drop Delta

Pre-Resignation Planning

Resigning from Delta requires more planning than dropping other plans:

The Resignation Process

Timing: Most dentists time Delta resignations for their contract anniversary (typically January 1) to avoid mid-year complications. However, Delta typically requires 30-90 days' notice even for renewals.

Legal Considerations: Be cautious about stopping to accept new Delta patients before your resignation is effective. Delta has strict non-discrimination requirements. The safest approach is to continue accepting all patients during your contract term, then stop after your resignation is effective.

Patient Communication: Give Delta patients 60-90 days' notice before your resignation is effective. Meet face-to-face with your best patients. Explain your reasoning and help them understand they can still use their benefits as out-of-network.

One Dentist's Surprise Discovery

A practice that had successfully resigned from Delta made an unexpected discovery: they could collect patient payments directly and have patients submit their own claims to Delta for out-of-network benefits. This discovery—which came as a surprise to the dentist—meant their out-of-network patients could actually get partial reimbursement.

The lesson: Understand the out-of-network benefits available to your patients. Many assume they lose benefits entirely when you drop an insurance plan. In reality, out-of-network benefits are usually still available. Help patients understand this—it often eliminates their primary objection to your resignation.

The Delta Transition Over Time

Year 1 of After Resignation

Expect to lose 10-20% of your Delta patients initially. Most stay because they value you as their dentist. Schedule may feel lighter, but new patient acquisition systems should be filling in quickly.

Year 2 of After Resignation

Your new patient base stabilizes. Collections typically improve significantly as you're not writing off Delta's discounted fees. Overhead begins to drop as insurance administration decreases.

Year 3 and Beyond

You're fully transitioned. Your practice generates more revenue with fewer patients because you're not dealing with insurance discounts. Team satisfaction improves. You have autonomy over treatment planning.

Key Takeaways for Delta

• Delta's market dominance means negotiation leverage is limited—don't waste months on futile negotiations
• The Premier vs. PPO distinction is diminishing—analyze your specific numbers before deciding which (if any) to keep
• Successful Delta resignation requires extensive preparation, particularly for new patient acquisition
• The changing dynamics favor practices eventually—enforcement of out-of-network assignments makes resignation more feasible
• A well-executed Delta resignation often becomes the catalyst for overall practice transformation

Reviewed by

Naren Arulrajah

CEO & Founder, Ekwa Marketing

Naren Arulrajah is the CEO and Founder of Ekwa Marketing, a 300-person dental marketing agency that has helped hundreds of practices grow through SEO, reputation management, and digital strategy. A published author of three books on dental marketing, contributor to Dentistry IQ, co-host of the Thriving Dentist Show and the Less Insurance Dependence Podcast, and a member of the Academy of Dental Management Consultants. He has spent 19 years focused exclusively on helping dental practices succeed online.