Home < Human
Resources and Benefits Briefing < November
2005
Delta Dental Plan: network dentist the wisest choice
To get the most from your Delta Dental Plan, select a Delta Dental PPO dentist. PPO dentists are Delta dentists who have agreed to charge PPO enrollees reduced fees. When you visit a PPO dentist, you will receive better benefits and lower out-of-pocket costs.
If you choose a dentist who is not in the PPO network, your best choice is a Delta Dental Premier dentist. Although their fees are higher than PPO dentists, they cannot charge more than their Delta-allowed fees. You won’t receive this cost protection and other conveniences when you visit a non-Delta dentist.
Non-Delta dentists do not participate in any Delta networks and have not agreed to Delta’s determination of fees. As a result, your costs could be higher than those of a Delta dentist. You could be responsible for any amount the dentist charged above Delta’s allowed amount, and might experience balance billing from non-Delta dentists.
Example of costs and savings under the Delta Dental plan
(This example is for illustration purposes only as amounts differ
by procedure and dental office.)
Under the Delta Dental plan, your out-of-pocket cost may vary depending on what type of dentist you visit.
| Basic services Benefit coverage |
PPO dentists 80% |
Non-PPO dentists 75% |
|
| Dentist | Delta Dental PPO dentist | Delta Dental Premier dentist | Non-Delta dentist |
| Delta allows | $130 | $160 | $160 |
| Dentist charges | $200 | $200 | $200 |
| Delta pays | $104 | $120 | $120 |
| Patient pays | $ 26 | $ 40 | $ 80 |
| Patient savings (compared with non-Delta dentist | $ 54 | $ 40 | $ 0 |
Additional advantages when you visit a Delta Dental dentist:
| Delta Dental PPO (and Delta Dental Premier) dentists | Non-Delta dentists |
| Claim forms are completed at no charge. | You may have to complete and submit your claim form or pay a service fee. |
| You can be charged only for the patient share during your visit. | You may have to pay the entire fee at the time of services and then submit a claim to Delta Dental in order to be reimbursed. |
| No balance billing. | You are responsible for any amount the dentist charges above Delta Dental’s allowed fee (the dentist may balance bill). |
Delta Dental’s dentist networks are among the largest, with more than 24,300 dentists — including 12,200 PPO dentist locations — in California and almost 160,000 dentist locations nationwide — including more than 84,000 PPO dentist locations. To check if your current dentist is a Delta Dental PPO or Premier dentist or for a list of these dentists in your area, visit your customized web site: http://www.deltadentalca.org/uc. Or call our automated service toll-fee: (800) 777-5854.
