Choosing a Dentist

TM Delta Dental PPO (Point-of-Service) Stay in network and save As a Delta Dental PPO (Point-of-Service) member, you may see any dentist you like. However, you will likely save the most money and receive the highest level of coverage when you visit a Delta Dental PPO dentist. Delta Dental • No balance billing on covered services PPO dentists • Most signi昀椀cant network discounts with more than 379,300 o昀케ce locations nationwide* • Dentists 昀椀le claims for member Delta Dental • No balance billing on covered services Premier® • Signi昀椀cant network discounts with the most o昀케ce locations nationwide—444,000* dentists • Dentists 昀椀le claims for member Out-of-network • Balance billing dentists • No network discounts • May need to 昀椀le own claims How it works: As shown below, your lowest out-of-pocket costs result from going to a Delta Dental PPO dentist. Example savings for a crown by network Submitted Maximum Percentage Amount Amount Total Total charge allowed paid by Delta dentist can amount network fee Delta Dental Dental pays balance bill you pay savings $ $ $ $ $ $ Delta Dental PPO 1,100 754 50% 377 0 377 346 $ $ $ $ $ $ Delta Dental Premier 1,100 988 50% 494 0 494 112 $ $ $ $ $ $ Out-of-network 1,100 798 50% 399 302 701 0 Delta Dental PPO dentists Delta Dental Premier dentists Out-of-network dentists Delta Dental PPO dentists have Delta Dental Premier dentists have agreed Out-of-network dentists have not agreed to agreed to charge $754 for the to charge $988—a savings of $112compared charge lower fees and can bill the full $1,100. $1,100 service, a savings of to the fee the dentist usually charges. Delta For payment to nonparticipating dentists, Delta $346. Your Delta Dental plan Dental’s payment is based on the maximum Dental establishes a nonparticipating dentist covers 50 percent of the cost. allowed fee amount of $988. Assuming you’ve fee, which is the maximum fee allowed for the Assuming you’ve already met met your deductible, Delta Dental will cover procedure, meaning Delta Dental pays $399. your deductible for the year, 50 percent of that $988, paying $494. With The dentist can bill you the di昀昀erence between Delta Dental will pay $377 a Delta Dental PPO (Point-of-Service) plan, the Delta Dental’s payment and what they charge. and you’ll pay $377. dentist cannot bill you the di昀昀erence between This leaves you with a bill of $701, which Delta Dental’s payment and the Delta Dental includes the $302 the out-of-network dentist Premier maximum allowed fee. can “balance bill.” NOTE: Payment examples above are illustrative only. Fees and reimbursements can vary by location and dentist. They do however represent how payment is determined. *Delta Dental Plans Association, June 2022. Find Delta Dental participating dentists near you by using the search feature on our website or by calling Delta Dental toll-free at 800-524-0149. FLI-6241-TRI-POS v2 Delta Dental of Michigan, Ohio, and Indiana C3 10/23