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How does Delta Dental PPO work?
Delta Dental PPO is a nationwide, fee-for-service plan that allows you to visit any licensed
dentist. Under this plan, your dentist is paid for each service. You may be responsible for a
deductible or copayment for certain services (check your Evidence of Coverage for a list of your
benefits) and any amount above your annual maximum. Here’s an example of how a copayment
works: if your program covers a procedure at 80 percent, you would be responsible for the
remaining 20 percent of the dentist’s approved fee.
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What are the advantages of visiting a Delta Dental dentist?
When you visit a Delta Dental dentist:
- You do not pay the entire bill and wait for reimbursement from Delta Dental. Instead, Delta Dental pays its portion directly to your dentist. We send you a notice explaining your portion of the
bill. You pay the dentist only that amount.
- Your costs may be lower because Delta Dental dentists agree to our determination of fees. If you are
responsible for a 20 percent copayment, you pay 20 percent of your dentist's allowed fee.
Also, Delta Dental makes sure you are not charged extra for services that should be included in the
cost of a treatment. For example, when you receive a crown, you cannot be charged additional
fees for tooth preparation, local anesthesia, an impression or a temporary crown.
- The dentist handles all claim forms and other paperwork for you.
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How do I know if my dentist is a Delta Dental dentist?
Approximately three out of four dentists are Delta Dental dentists, so there’s a good chance yours is too.
Ask your dentist if he or she is a Delta Dental member. If you do not have a personal dentist, our web site
has a dentist directory service to help you locate a Delta Dental dentist, as well as a map to each office location and additional information about our dentists. You also can call our automated telephone directory service toll-free at 800-4-AREA-DR (800-427-3237) to request a list of Delta Dental dentists near you.
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Where do I get claim forms?
Because Delta Dental dentists agree to handle claim forms and other paperwork at no charge, you do not
need to bring claim forms to a Delta Dental dentist. If you visit a non-Delta Dental dentist, Delta Dental will accept any standard claim form or itemized receipt. Claims can be downloaded from our web site or can be faxed to you by dialing toll-free 877-226-1974.
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My dentist is not a Delta Dental dentist. Can I still visit him/her?
Yes, your Delta Dental PPO plan allows you to visit any dentist. However, when you go to a non-Delta Dental dentist, you do not receive the advantages of visiting a Delta Dental dentist outlined above.
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How do I change dentists?
You can change dentists as often as you need to — you don’t even need to notify us. If you wish,
every member of your family can visit a different dentist.
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How can I obtain eligibility and benefits information?
Our secured web site allows enrollees to view information about coverage for yourself and family
members, including maximums and deductibles, benefit levels for standard and orthodontic
coverage, and details such as the number of cleanings covered in a year. For those without Internet
access, our Delta Dental Information Access Line (1-888-335-8227) gives you the same information
through your touchtone phone. We also have a service called BeneFax (1-888-335-8227) that sends
detailed benefits summaries directly to your fax machine.
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What if I lose a filling while I'm traveling away from home?
Your plan covers you and any eligible dependents anywhere in the world — even in situations that
are not an emergency.
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What happens if I have Delta Dental, and my spouse has coverage with another company?
When you are covered by two dental plans, you have “dual coverage.” While your benefits will not
be doubled, the two carriers will coordinate your benefits, so you may enjoy lower out-of-pocket
costs.
If, for example, both plans provide two cleanings a year with 80 percent coverage, you are not
covered for four cleanings. Instead, the primary plan (the one offered by your employer) pays 80
percent, and the secondary plan will often cover up to the remaining 20 percent.
Different rules apply for some groups, so check your Evidence of Coverage booklet. Some plans
have a rule that limits benefits to those of the secondary plan. In this case, the total benefit would
be limited to 80 percent. You are responsible for paying the remainder.
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How can I be sure I'll be able to afford the treatment my dentist recommends?
If you are considering major treatment such as oral surgery, crowns or dentures, your dentist can
request a predetermination from Delta Dental. This free service helps you find out in advance what
your program covers and how much your treatment will cost. Your dentist submits a proposed
treatment plan to us, and we calculate your share of the cost.
Also, to be sure you are getting the best value from your dental plan, we recommend you visit a
Delta Dental dentist. Delta Dental dentists limit their charges to fees determined by Delta Dental.
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