Delta Dental in Network – How important is it to stay in network?

Posted on: Friday, September 11th, 2015 by Aliso Park Dental Staff
You may already realize that one of the main benefits of having a PPO Insurance, is the freedom to choose who you would like to be your dentist. This is not the case with most HMO's, and many times it leaves the patient frustrated at the lack of flexibility and control over their own dental health. What you may not realize is this, you could be saving thousands of dollars by going to an in network PPO provider vs.  a dentist that accepts your insurance, but is NOT an "in network provider." How can you save money?  When a dentist contracts with Delta Dental of California (for example) he or she agrees to reduce their Usual and Customary Rates (UCR) to a reduced fee schedule. That fee scheduled amount can potentially be up to 50% off the dentists' usual fee! When one undertakes a costly procedure, such as a crown, the Delta Dental contracted dentist who might usually charge $1,400 for the procedure, is under contractual obligation to ONLY charge the patient $737 (this is known as the "maximum allowable charge"). Let's take the figures above and calculate the difference:

If your Delta benefit for crowns is 50%, and the dentist who performs the crown is an in network Delta PPO Provider, that crown will cost $737 and Delta will pay $368.50 and you will pay the same. If you go to an out of network provider however, and the dentist charges $1400, Delta will still only pay $368.50, and you will end up paying $1,031.50 out of pocket. You save $663.00 by going to an in network provider! If you are in need of extensive dental work, that difference can add up quickly.

Many patients will ask when on the phone for the first time with a dental office: "Do you accept my insurance?"  To which many dental offices will answer a very misleading: "yes."  The better question to ask is: "Are you in network with my insurance?" This obligates the dental office to be specific, and if they are not in network, you will understand that your out of pocket expense by being treated by this dentist may potentially cost you thousands of dollars more than necessary. We at Aliso Park Dental have taken the initiative to contract with most major insurance companies, Delta Dental being one of them. In doing so, we are maximizing the benefit for both our patients and ourselves. Staying in network, when seeking dental care, is a win win for both of us. :0)  

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