Stay in network and save

FLI-6241-TRI-STD v4 C3 9/24 Delta Dental of Michigan, Ohio, and Indiana Stay in network and save As a Delta Dental PPO (Standard) 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 PPO dentists • No balance billing on covered services • Most significant network discounts with more than 395,000 office locations nationwide* • Dentists file claims for member Delta Dental Premier® dentists • Provider charges cannot exceed the maximum allowed fee for Delta Dental Premier dentists • Significant network discounts with the most office locations nationwide—460,000* • Dentists file claims for member Out-of-network dentists • Balance billing • No network discounts • May need to file 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 charge Maximum approved fee Delta Dental PPO fee schedule Percentage paid by Delta Dental Amount Delta Dental pays Amount dentist can balance bill Total amount you pay Total network savings Delta Dental PPO $1,100 $754 $754 50% $377 $0 $377 $346 Delta Dental Premier $1,100 $988 $754 50% $377 $234 $611 $112 Out-of-network $1,100 $1,100 $754 50% $377 $346 $723 $0 Delta Dental PPO dentists Delta Dental Premier dentists Out-of-network dentists Delta Dental PPO dentists have agreed to charge $754 for the $1,100 service, a savings of $346. Your Delta Dental plan covers 50 percent of the cost. Assuming you’ve already met your deductible for the year, Delta Dental will pay $377 and you’ll pay $377. Delta Dental Premier dentists have agreed to charge $988—a savings of $112 compared to the fee the dentist usually charges. Delta Dental’s payment is based on the Delta Dental PPO fee schedule amount of $754. Assuming you’ve met your deductible, Delta Dental will cover 50 percent of that $754, paying $377. With a Delta Dental PPO (Standard) plan, the dentist can bill you the difference between Delta Dental’s payment and the Delta Dental Premier maximum allowed fee, leaving you to pay $611. Out-of-network dentists have not agreed to charge lower fees and can bill the full $1,100. Delta Dental’s payment is based on the Delta Dental PPO fee schedule, which means Delta Dental’s pays $377. The dentist can bill you the difference between Delta Dental’s payment and what they charge. This leaves you with a bill of $723, which includes the $346 the out-of-network dentist 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, December 2023. 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 Delta Dental PPOTM (Standard)