Dental Plan Network Savings
Delta Dental offers an extensive two-tier nation-wide network of providers – the Delta Dental Premier Network and the Delta Dental PPO Network. The level of eligible charges (based on network discount) will vary depending on whether you use a network provider and/or the network in which your provider participates.
Delta Dental Premier Network
- Larger network – 118,000 dentists in 163,000 offices
- Delta premier discounts
- No balance billing
- No paperwork
Delta Dental PPO Network
- Smaller network – 57,000 dentists in 88,000 offices
- Deepest discounts
- No balance billing
- No paperwork
Locate Network Providers
- Call your dentist and ask, “Do you accept Delta Dental?”
- Go to www.deltadentalks.com and search for dentists in your area.
- Call Delta Dental at 1-800-234-3375
| Example of Preventive Payment (Not Subject to Deductible) |
Premier Network | PPO Network | Out-of-Network |
Cleaning, Bitewing X-rays and Exam |
|||
Dentist’s Charge |
$115 | $115 | $115 |
Delta’s Maximum Allowance (MPA)* |
$108 | $91 | $82 |
Plan Pays 100% of MPA |
$108 | $91 | $82 |
Patient Coinsurance = 0% of MPA |
$0 | $0 | $0 |
Additional Amount Provider Can Charge (balance bill) |
$0 | $0 | $33 |
Total Patient Charge |
$0 | $0 | $33 |
Example of Major Procedure |
Premier Network |
PPO Network |
Out-of-Network |
| Crown | |||
Dentist’s Charge |
$725 | $725 | $725 |
Delta’s Maximum Allowance (MPA)* |
$700 | $616 | $525 |
Plan Pays 50% of MPA |
$350 | $308 | $262.50 |
Patient Coinsurance = 50% of MPA |
$350 | $308 | $262.50 |
Additional Amount Provider Can Charge (balance bill) |
$0 | $0 | $200 |
Total Patient Charge |
$350 | $308 | $462.50 |
Above charges are shown for illustration purposes only. Your experience may vary.
Maximum Allowable Charges (MPA) for a covered procedure means the fee established by Delta Dental. Delta develops the MPA from a number of sources, including but not limited to contract with dentists, input from dental consultants, the billed charges for the same procedures by dentists in that state, and other pertinent information. The MPA for in-network procedures ranges between approximately 70-80% of retail cost. The MPA for out-of network procedures ranges between 50-60% of retail cost. Other insurance companies or your dental provider may refer to this as “reasonable and customary” or R&C maximums. In addition, if a Delta Dental provider is used, the contract between the dentist and Delta Dental does not allow the dentist to bill you for the charges over the MPA (balance billing). However, using an out-of-network provider will put more of the cost on the participant because of the lower MPA and balance billing.