Delta Dental PPO FAQs
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What is a Delta Dental PPO Provider?
A Delta Dental PPO Provider offers a lower premium to the purchaser than most other fee-for-service programs. This premium reduction is possible because the administrator contracts with dentists to provide care at lower than average reimbursement levels. While the dentists agree to accept what may be lower fees, they are still paid on a fee-for-service basis.
In a PPO, the patient has the freedom to choose a dentist on a treatment-by-treatment basis. While in most cases patients can receive services from non-participating dentists outside the panel, there is an economic incentive to seek care from a PPO dentist because out-of-pocket costs are less.
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Why did Delta Dental developed Delta Dental PPO?
Delta Dental PPO was developed to satisfy a demand in the marketplace for better cost containment. The program coincides with the principles maintained by the dental profession. For instance, dentists will be paid on a fee-for-service basis. Patients are free to receive their dental treatment from the dentist of their choice (whether or not the dentist is in the Delta Dental PPO panel). Participation by the dentist in the panel is voluntary.
Essentially, Delta Dental PPO provides a viable fee-for-service alternative while incorporating some of the features of cost containment demanded by today's purchasers.
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What are the benefits of becoming a Delta Dental PPO participating panel dentist?
Delta Dental PPO participating panel dentists may experience an increase in patients through participation. Subscribers of groups who purchase Delta Dental PPO will be encouraged to choose a Delta Dental PPO panel dentist. A current list of Delta Dental PPO participating panel dentists along with their specialty and practice locations will be made available to employers. Subscribers who receive care from a dentist who is not a participating Delta Dental PPO panel dentist will incur greater out-of-pocket expenses.
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What benefit levels will Delta Dental PPO subscribers have?
Just as in Delta Dental Plan's traditional programs, the benefit levels of Delta Dental PPO will vary according to the needs of the purchasing group. Some services may be covered at 100%, while others may have patient co-payments. These programs will also have annual maximums, deductibles, and coordination of benefits provisions.
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How are participating panel dentists paid?
The payment made to panel dentists will be the lesser of the dentist's actual fee charged for the service rendered, or the amount listed in the Delta Dental PPO Table of Allowance.
Delta Dental PPO participating panel
dentist's cannot charge the patient the difference, if any, between the table amount and their fee. Similar to the
Delta Dental Premier program, Delta Dental PPO participating panel dentists receive payment directly from Delta Dental.
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Will participating panel dentists receive less than they do for Delta Dental's traditional programs?
Not necessarily. It depends on the participating panel dentist's usual fees. What may vary is the patient's co-payment, just as it does in Delta Dental Plan's traditional programs.
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How often will the Delta Dental PPO Table of Allowance be updated?
The Delta Dental PPO Table of Allowance is reviewed annually.
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Will the Delta Dental PPO program affect my Delta Dental Premier fee profile?
No. There is no impact on your fee profile by the Delta Dental PPO
program. Charge data for Delta Dental PPO patients are not included in the profile update process.
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Why aren't there any orthodontic allowances listed on the
Delta Dental PPO Table of Allowance?
We do not currently offer separate Delta Dental PPO orthodontic benefits. If purchasers want to include orthodontic benefits under the Delta Dental PPO plan, we will provide our standard Delta Dental Premier orthodontic rider. Therefore, it is not necessary for orthodontists to enroll as Delta Dental PPO participating panel dentists at this time.
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What else is different about Delta Dental PPO?
Very little will differ from Delta Dental Plan's traditional programs. Dental processing policies, time limitations and reporting requirements will be maintained. Delta Dental Plan's regular professional review activities will also be conducted for Delta Dental PPO. Delta Dental PPO is a managed care program, and dentists will be required to meet our credentialing criteria.
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What do I need to know about the credentialing process required for participation in Delta Dental PPO?
Delta Dental PPO dentists are required to complete the credentialing and site review process as part of their application.
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If I'm not happy with Delta Dental PPO, can I terminate?
Yes. Upon 90 days written notice, dentists may terminate participation in Delta Dental PPO. This termination will not affect participation status in any other Delta Dental Plan networks.
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If you have any additional questions about Delta Dental PPO, please call the Professional Relations department at (617) 886-1160 or 1-800-451-1249 x1160.
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