The Delta Dental PPO plan features a unique three-tier reimbursement arrangement that increases savings and reduces balance billing. In a traditional PPO, in-network providers agree to a schedule. In this traditional model, it’s the only reimbursement tier that protects members from balance billing.
Delta Dental provides an exclusive second network of Premier dentists. Providers discount their own UCR fee by an average of 10% to 29%. Those real savings are passed on to members. For any given procedure, non-contracted providers are paid on an average based on all claims submitted to Delta Dental in the previous year.
To simplify:
- No balance billing: PPO dentists are paid in-network up to the agreed schedule (35%-41% off UCR)
- No balance billing: Premier dentists are paid out-of-network up to the agreed fees (10%-29% off UCR)
- Non-contracted providers are paid out-of-network up to the area average per-procedure
Contact CoPower about offering Delta Dental to your groups.
Austin Kikuchi
Sales Account Representative
austin.kikuchi@copower.com
650-931-1737