Network Dentist Savings
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With your dental benefit program, you are free to go to any licensed dentist. However, in many cases, you can reduce your out-of-pocket expenses by using a Delta Dental PPO or Delta Dental Premier network dentist.
Click here for a guide to help you find a network dentist.
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How do you save with a Delta Dental Network Dentist?
Dentists who participate in Delta Dental PPO and Delta Dental Premier networks agree to accept an allowed fee as payment and cannot charge you the difference between his/her submitted fee and the allowed fee. Delta Dental PPO and Premier network dentists cannot bill you upfront for any charges other than applicable deductible and coinsurance amounts.
With your Schedule of Benefits, a non-network dentist can charge you for the difference between his/her submitted amount and the Schedule of Benefits amount.
Delta Dental PPO dentists agree to accept our allowed PPO fees as payment in full. If Delta Dental’s allowed PPO amount is lower than the Schedule of Benefits amount, Delta Dental PPO dentists cannot balance bill you for the difference. This means you may save money and stretch your benefit dollars – the less the claim reimbursement, the less dollars applied to your annual maximum. If Delta Dental’s allowed PPO amount is lower than the Schedule of Benefits amount, Delta Dental PPO dentists cannot balance bill you for the difference.
Delta Dental Premier is a safety net for our Delta Dental PPO network. Delta Dental Premier dentists agree to our maximum plan allowances as payment in full, which may be lower than what a dentist would typically charge. If Delta Dental’s maximum allowed amount is lower than the Schedule of Benefits amount, Delta Dental Premier dentists cannot balance bill you for the difference. You will pay more out-of-pocket with a Delta Dental Premier dentist compared to a Delta Dental PPO dentist. However, you may save more money with a Delta Dental Premier dentist compared to a non-network dentist.
Important Note: In some cases, the Delta Dental allowed fees for Delta Dental PPO and Delta Dental Premier network dentists may be greater than the Schedule of Benefits fee, but less than the dentist’s submitted fee. In these instances, Delta Dental PPO and Premier dentists can only bill you the difference between the Schedule of Benefits fee and Delta Dental’s allowed fee.
If you go to a non-network dentist, you will still receive benefits, but you may have to pay more because these dentists have not agreed to Delta Dental’s allowed fees and these dentists can balance bill you for the difference between their submitted fee and the Schedule of Benefits fee. If you use a non-network dentist, you generally must pay the entire bill at the time of service and/or file your own claim, depending on the payment arrangements you make with your dentist.
Note: You may elect to have reimbursement sent directly to a non-network dentist, referred to as assignment of benefits, if the dentist accepts assignment. You must consent to authorize payment of benefits directly to a non-network dentist. If you do, the dentist cannot collect any payment from you at the point of service other than any applicable fees such as deductibles, copayments and amounts over the Schedule of Benefits.
Please see the following example that demonstrates how you can save with a Delta Dental network dentist This is a hypothetical example only and assume all deductibles have been met.
| Delta Dental PPO Dentist |
Delta Dental Premier Dentist |
Non-Network Dentist |
| Dentist Submitted Fee - $1,000 |
Dentist Submitted Fee - $1,000 |
Dentist Submitted Fee - $1,000 |
| Delta Dental PPO allowed fee - $600 |
Delta Dental Premier maximum plan allowance - $900 |
No negotiated amount - $0 |
| Schedule of Benefits Fee - $781 |
Schedule of Benefits Fee - $781 |
Schedule of Benefits Fee - $781 |
| Your Out-of-Pocket Costs - $0 |
Your Out-of-Pocket Costs - $119 |
Your Out-of-Pocket Costs - $219 |