Your coverage has not changed; however, you now have the benefit of Delta Dental’s expansive dental networks. You can still go to any licensed general or specialty dentist, regardless of whether the dentist participates in one of our networks. In many cases, you can reduce your out-of-pocket expenses by using a Delta Dental PPO or Delta Dental Premier network dentist.
How Does the Addition of Dental Networks Affect Your Dental Program?
When a dentist participates in a network, he/she agrees to accept an allowed fee as payment and cannot charge you the difference between his/her submitted fee and the allowed fee. With your Schedule of Benefits, and as your plan has worked in the past, a non-network dentist can charge you for the difference between his/her submitted fee and the Schedule of Benefits fee. Using a Delta Dental PPO or Delta Dental Premier dentist can maximize savings for both you and your covered dependents and the State itself.
Delta Dental PPO is our national preferred provider dental network. If you go to a Delta Dental PPO dentist, your out-of-pocket expenses often will be less because these dentists accept the lesser of their submitted fee or our reduced PPO fee as payment-in-full (less any deductible). If Delta Dental’s allowed PPO fee is lower than the Schedule of Benefits fee, Delta Dental PPO dentists cannot balance bill you for the difference.
Delta Dental Premier is our national dental network that works with Delta Dental PPO to provide network savings and protections for those who don’t use a Delta Dental PPO network dentists. Delta Dental Premier dentists agree to accept the lesser of their submitted fee or Delta Dental’s maximum allowed fee as payment-in-full (less any deductible). If Delta Dental’s maximum allowed fee is lower than the Schedule of Benefits fee, Delta Dental Premier dentists cannot balance bill you for the difference.
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 may have to pay the entire bill upfront at the time of service and/or file your own claim, depending on the arrangements you make with the dentist. Network dentists - Delta Dental PPO and Premier - are reimbursed directly by Delta Dental of Illinois. Now, 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.
If you use a Delta Dental PPO or Delta Dental Premier network dentist, in addition to your out-of-pocket savings, you can maximize your benefit dollars – the lower the claim reimbursement, the less dollars applied to your annual maximum.
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 amount||$1,000||Dentist submitted amount||$1,000||Dentist submitted amount||$1,000|
|PPO allowed amount||$600||Premier maximum allowed amount||$900||No negotiated amount||$0|
|Schedule of Benefits amount||$781||Schedule of Benefits amount||$781||Schedule of Benefits amount||$781|
|Your Out-of-Pocket Cost||$0||Your Out-of-Pocket Cost||$119||Your Out-of-Pocket Cost||$219|
You have access to the Delta Dental PPO and Delta Dental Premier networks. (Please note: DeltaCare USA is a dental HMO product and does not apply to your plan.)
Click here for a guide to help you find a network dentist.
Use the Subscriber Connection to access claims status, retrieve benefit and eligibility information, print a temporary ID card and more. Click here for information about how to register for the Subscriber Connection.
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