Delta Dental Premier Insurance Information Essentials

The following information is provided for those who have Delta Dental Premier dental insurance benefits. It is not an endorsement. This is provided because numerous patients in this vicinity have this insurance. The content is taken directly from: Premier Participation FAQs | Delta Dental of Michigan (deltadentalmi.com).

Dr. Gar N. Chan is a Delta Dental Premier Dentist

What is Delta Dental?

Delta Dental is a nonprofit, group dental benefit administrator with over 60 years of experience in helping Americans access oral health services. As the leading dental benefits carrier, Delta Dental has provided coverage to more Americans than any other carrier, ensuring that individuals have financial support for their oral health needs. Their mission is to educate and empower people to take responsibility for their oral health, promoting overall well-being.

What is Delta Dental Premier®?

Delta Dental Premier is a widely recognized standard fee-for-service dental benefits program. Participating dentists are reimbursed directly by Delta Dental based on their submitted fees and the maximum approved fee. Members are responsible for copayments, deductibles (if any), and charges for non-covered services.

What is the Delta Dental Premier network?

The Delta Dental Premier network consists of over 156,200 dentists practicing in nearly 349,200 locations across the United States and its territories. Approximately four out of five dentists participate in one or more Delta Dental programs, providing an extensive network for members to access quality dental care.

(Source: Delta Dental Plans Association, September 2019)

What are the advantages of participating in Delta Dental Premier?

Participating in Delta Dental Premier offers several benefits for dentists, including:

  • Direct payment: Delta Dental reimburses participating dentists directly for each covered service rendered.
  • New and retained patients: Being a part of the Delta Dental Premier network can attract new patients who have the motivation and financial support to seek dental care.
  • Superior service and assistance: Delta Dental is known for its exceptional customer service, providing support and assistance to both dentists and members.

Is Delta Dental Premier a capitation/DHMO or PPO program?

No, Delta Dental Premier is neither a capitation/DHMO (dental health maintenance organization) nor a PPO (preferred provider organization) program. Delta Dental directly pays participating dentists for each covered service rendered based on the lesser of the submitted fee or Delta Dental’s maximum fee allowance. Members can receive care from any licensed dentist, but they can save on out-of-pocket costs and administration by choosing a Delta Dental Premier dentist.

What does the dentist agree to when signing a Delta Dental Premier agreement?

When dentists sign a Delta Dental Premier agreement, they agree to:

  • Follow the Uniform Requirements and processing policies outlined by Delta Dental.
  • Charge members their applicable copayments.
  • Accept payment directly from Delta Dental for covered services.

How are participating dentists paid in the Delta Dental Premier program? What is the fee policy?

Participating dentists in the Delta Dental Premier program are paid for each covered service rendered. Delta Dental’s payment to dentists is based on the lesser of the dentist’s submitted fee or the maximum fee approved by Delta Dental for a specific procedure in a given region of the state, applicable to all Delta Dental-covered patients.

How often are fees reviewed or increased?

Delta Dental reviews the fees at least twice a year and makes necessary updates based on various factors.

Can the patient be billed the difference between the approved amount and the submitted fee?

No, the difference between the approved amount and the submitted fee cannot be charged to the patient. The reimbursement may come from Delta Dental, the patient, or a combination of both parties, but the total amount charged cannot exceed the approved amount.

How does one determine if a patient is eligible for Delta Dental Premier benefits?

Participating Delta Dental Premier dental offices can verify eligibility and access benefits and claims information online through the Dental Office Toolkit®. They can also use DASI, Delta Dental’s automated voice response system, by calling 800-524-0149. Additionally, a summary of dental benefits can be requested by selecting the FaxBack option. For patients with dental coverage through a national group, they can visit the Delta Dental portal at www.deltadental.com.

Is the dentist expected to file claims for Delta Dental-covered patients?

Yes, dentists are expected to file claims for Delta Dental-covered patients. Delta Dental offers convenient solutions to streamline the claims process. Dentists can submit claims electronically at no charge using the Dental Office Toolkit®. Alternatively, they can use a clearinghouse, which may charge a per-claim or monthly fee, or mail paper claims to Delta Dental.

How do Delta Dental-covered patients and members know that I am a Delta Dental Premier participating dentist?

To assist new and existing Delta Dental members in locating your office, Delta Dental provides listings of participating dentists on their websites, the online Consumer Toolkit®, and through DASI.

Please note that the content provided above is taken from the source mentioned and may be subject to change.