Understanding our networks

Delta Dental Premier |  Delta Dental PPO  |  DeltaCare  |  Delta Dental EPO

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Delta Dental Premier is our traditional fee-for-service program in which dentists submit usual fees, and are reimbursed based on a maximum approved fee. Over 95% of the state's licensed dentists participate in Delta Dental Premier.

Reimbursement
Reimbursement for Delta Dental Premier patients is based on a regional fee schedule which is reviewed annually. Delta Dental pays participating dentists directly for each covered service rendered based on the lesser of the submitted fee or the fee published in Delta Dental’s Premier fee schedule.

  

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Delta Dental PPO is our preferred provider organization program in which dentists accept reduced fees, resulting in enrollee savings and lower group rates.

Reimbursement
Reimbursement for Delta Dental PPO patients is based on a regional fee schedule which is reviewed annually. Delta Dental pays participating dentists directly for each covered service rendered based on the lesser of the submitted fee or the fee published in Delta Dental’s PPO fee schedule. Patients eligible for benefits can receive care from any dentist they choose, but they can lower their out-of-pocket costs by choosing a Delta Dental PPO participating dentist.
  

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DeltaCare is our dental health management program in which dentists receive a fixed monthly fee for each patient. Members choose a Primary Care Dentist (PCD) from our network to manage their dental care.

Reimbursement
Primary care dentists are reimbursed through a combination of fixed monthly capitation payments, lab fee supplements, specialty payments, and member co-payments that are collected directly from the patient. Participating DeltaCare PCDs receive a fixed monthly fee for each DeltaCare patient regardless of whether the patient receives treatment in a given month. Specialty services are reimbursed based on the appropriate regional Delta Dental PPO fee schedule for the treating dentist’s specialty. We limit the number of dentists in each geographic area so that we can guarantee adequate patient flow.