DentalPreferred FAQs
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What is a Preferred Provider Option (PPO)?
A dental Preferred Provider Option offers a lower premium to the purchaser than most other fee-for-service programs. This premium reduction is possible because the administrator contracts with dentists to provide care at lower than average reimbursement levels. While the dentists agree to accept what may be lower fees, they are still paid on a fee-for-service basis.
In a PPO, the patient has the freedom to choose a dentist on a treatment-by-treatment basis. While in most cases patients can receive services from non-participating dentists outside the panel, there is an economic incentive to seek care from a PPO dentist because out-of-pocket costs are less.
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Why did Delta Dental develop DeltaPreferred Option?
DeltaPreferred Option was developed to satisfy a demand in the marketplace for better cost containment. The program coincides with the principles maintained by the dental profession. For instance, dentists will be paid on a fee-for-service basis. Patients are free to receive their dental treatment from the dentist of their choice (whether or not the dentist is in the DeltaPreferred Option panel). Participation by the dentist in the panel is voluntary.
Essentially, DeltaPreferred Option provides a viable fee-for-service alternative while incorporating some of the features of cost containment demanded by today's purchasers.
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What are the benefits of becoming a DeltaPreferred Option participating panel dentist?
DeltaPreferred Option participating panel dentists may experience an increase in patients through participation. Subscribers of groups who purchase DeltaPreferred Option will be encouraged to choose a DeltaPreferred Option panel dentist. A current list of DeltaPreferred Option participating panel dentists along with their specialty and practice locations will be made available to employers. Subscribers who receive care from a dentist who is not a participating DeltaPreferred Option panel dentist will incur greater out-of-pocket expenses.
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What benefit levels will DeltaPreferred Option subscribers have?
Just as in Delta Dental's traditional programs, the benefit levels of DeltaPreferred Option will vary according to the needs of the purchasing group. Some services may be covered at 100%, while others may have patient co-payments. These programs will also have annual maximums, deductibles, and coordination of benefits provisions.
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How are participating panel dentists paid?
The payment made to panel dentists will be the lesser of the dentist's actual fee charged for the service rendered, or the amount listed in the DeltaPreferred Option Table of Allowance.
DeltaPreferred Option participating panel dentists cannot charge the patient the difference, if any, between the table amount and their fee. Similar to the DeltaPremier program, DeltaPreferred Option participating panel dentists receive payment directly from Delta Dental.
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Will participating panel dentists receive less than they do for Delta Dental's traditional programs?
Not necessarily. It depends on the participating panel dentist's usual fees. What may vary is the patient's co-payment, just as it does in Delta Dental's traditional programs.
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Will there be a 5% discount for DeltaPreferred Option?
Yes. As with our DeltaPremier dental plan, the 5% discount applies to payments for services rendered by all Massachusetts dentists, whether they are participating in the panel or not. This withhold is mandated by the Commonwealth of Massachusetts, General Laws, Chapter 176E. This money is not kept by Delta Dental of Massachusetts, but is passed along to the customer in the form of lower premiums.
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How often will the DeltaPreferred Option Table of Allowance be updated?
The DeltaPreferred Option Table of Allowance is reviewed annually.
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Will the DeltaPreferred Option program affect my DeltaPremier fee profile?
No. There is no impact on your fee profile by the DeltaPreferred Option program. Charge data for DeltaPreferred Option patients are not included in the profile update process.
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Why aren't there any orthodontic allowances listed on the DeltaPreferred Option Table of Allowance?
We do not currently offer separate DeltaPreferred Option orthodontic benefits. If purchasers want to include orthodontic benefits under the DeltaPreferred Option plan, we will provide our standard DeltaPremier orthodontic rider. Therefore, it is not necessary for orthodontists to enroll as DeltaPreferred Option participating panel dentists at this time.
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What else is different about DeltaPreferred Option?
Very little will differ from Delta Dental's traditional programs. Dental processing policies, time limitations and reporting requirements will be maintained. Delta Dental's regular professional review activities will also be conducted for DeltaPreferred Option. DeltaPreferred Option is a managed care program, and dentists will be required to meet our credentialing criteria.
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What do I need to know about the credentialing process required for participation in DeltaPreferred Option?
DeltaPreferred Option dentists are required to complete the credentialing and site review process as part of their application.
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If I'm not happy with DeltaPreferred Option, can I terminate?
Yes. Upon 90 days written notice, dentists may terminate participation in DeltaPreferred Option. This termination will not affect participation status in any other Delta Dental networks.
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If you have any additional questions about DeltaPreferred Option, please call the Professional Relations department at (617) 886-1160 or 1-800-451-1249 x1160.
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