Networks and Providers

Delta Dental Provider Networks
Covered individuals are encouraged to receive care from dentists who participate in one of two Delta Dental of Washington provider networks. These dentists offer their services at discounted rates, which can reduce your out-of-pocket dental expenses.

• The Delta Dental PPO℠ network provides the deepest discounts to you and your dependents.
• The Delta Dental Premier® network offer discounts as well, but are generally smaller than discounts offered by PPO dentists.

A third option available to covered individuals is the use of a non-network dentist, with the understanding that the provider has not negotiated a discounted fee arrangement with Delta Dental of Washington.

Regardless of the dentist you choose, be sure to present your Delta Dental ID card at the time of your appointment.

Search for Delta Dental Providers
Covered individuals save money when using dentists who participate in the available Delta Dental of Washington provider networks. These dentists provide services at discounted rates. There are two basic ways to locate these providers.

• Visit Delta Dental of Washington and create your patient account. Signing in will automatically guide you to dentists covered by your plan.
• Use the Delta Dental of Washington online provider search.
• In Washington: If you already have dentist, use the online provider search to verify whether s/he participates in one of the available networks. If you do not have a dentist, try to locate a Delta Dental PPO dentist first. (Remember, this network provides the deepest discounts to you and your dependents.) If your search is not successful, search again using the Delta Dental Premier network.
• Outside Washington: Search the national Delta Dental directory.

 

Fees, Discounts, and Claims

Fees and Discounts
The transition to Delta Dental of Washington (effective Jan. 1, 2014) does not impact the plan's current dental fee schedules and annual maximums. However, by receiving treatment from a dentist who participates in one of the available Delta Dental provider networks, you may further limit how much a dentist can charge for procedures. Here's how benefits will be paid:

• If the fee on the plan's dental fee schedule is higher than the Delta Dental network dentist's discounted fee, Delta Dental of Washington will pay that procedure based on the network dentist's discounted fee. The Delta Dental network dentist must honor his or her discounted fee and cannot bill you the difference. This represents important savings to you and the plan.
• If the fee on the plan's dental fee schedule is lower than the Delta Dental network dentist's discounted fee, Delta Dental of Washington will pay that procedure based on the dental fee schedule. You are responsible for the difference between the fee on the dental fee schedule and the network dentist's discounted fee with Delta Dental. This may still represent savings to you because the network dentist's discounted fee may be less than what the dentist charges patients who are not part of the Delta Dental network.
• If you use a non-network dentist, claims payments will be based on your dentist's actual charges or the amount allowed on the dental fee schedule, whichever is less.

Claims and Billing

• Network Providers: Using Delta Dental providers offers another advantage—� they handle the paperwork. They will submit your claim directly to Delta Dental of Washington and receive payment in return. If your dentist is allowed to charge you for the difference between the dental fee schedule and the discounted fee, he or she may request that portion of the payment at the time of service or bill you later. The EOB details how the claim was processed.

• Non-Network Providers: Ifyou use a non-network dentist, the patient is responsible for completing and signing claims forms and sending them to Delta Dental of Washington.