How Payment Is Made
If the dentist is a PPO dentist and a Premier dentist, Delta Dental will base payment on the lesser of:
  • The submitted amount
  • The PPO dentist schedule
  • The Maximum Approved Fee
Delta Dental will send payment to the PPO dentist, and the subscriber will be responsible for any difference between Delta Dental's payment and the PPO dentist schedule or the Maximum Approved Fee for covered services. The subscriber will be responsible for the lesser of the PPO schedule amount, the Maximum Approved Fee, or the dentist's submitted amount for most commonly-performed noncovered services. For other noncovered services, the subscriber will be responsible for the dentist's submitted amount.
If the dentist is a PPO dentist but is not a Premier dentist, Delta Dental will base payment on the lesser of:
  • The submitted amount
  • The PPO dentist schedule.
Delta Dental will send payment to the PPO dentist, and the subscriber will be responsible for any difference between Delta Dental's payment and the PPO dentist schedule for covered services. The subscriber will be responsible for the lesser of the PPO schedule amount or the dentist's submitted amount for most commonly-performed noncovered services. For other noncovered services, the subscriber will be responsible for the dentist's submitted amount.
If the dentist is not a PPO dentist but is a Premier dentist, Delta Dental will base payment on the lesser of:
  • The submitted amount
  • The Maximum Approved Fee
Delta Dental will send payment to the Premier dentist, and the subscriber will be responsible for any difference between Delta Dental's payment and the Maximum Approved Fee for covered services. The subscriber will be responsible for the lesser of the Maximum Approved Fee or the dentist's submitted amount for most commonly-performed noncovered services. For other noncovered services, the subscriber will be responsible for the dentist's submitted amount.
If the dentist does not participate in Delta Dental PPO or Delta Dental Premier, Delta Dental will base payment on the lesser of:
  • The submitted amount
  • The non-participating dentist Fee
Delta Dental will usually send payment to the subscriber, who will be responsible for making payment to the dentist. The subscriber will be responsible for any difference between Delta Dental's payment and the dentist's submitted amount.
For dental services rendered by an out-of-country dentist, Delta Dental will base payment on the lesser of:
  • The submitted amount
  • The out-of-country dentist fee
Delta Dental will usually send payment to the subscriber, who will be responsible for making payment to the dentist. The subscriber will be responsible for any difference between Delta Dental's payment and the dentist's submitted amount.