As part of the Affordable Care Act (ACA), Delta Dental has outlined the following transparency in coverage information for members enrolled in dental plans purchased through healthcare.gov.
Balance billing occurs when a dentist bills a member for charges—other than copayments, coinsurance or any amounts that may remain on a deductible—following Delta Dental's payment on a claim. Our network dentists agree to accept Delta Dental’s contracted fees as full payment and not to bill the member above that amount. Balance billing is not allowed within the Delta Dental network.
If the submitted amount for an out-of-network dentist is more than the allowed amount, the member is responsible for paying the dentist that percentage listed in the policy, as well as the difference between the submitted amount and the allowed amount. Nonparticipating dentists are under no obligation to limit the amount of their fees and the member will be responsible for paying the amount that is charged.
If an in-network dentist is not readily available within a reasonable period of time or driving distance, it may be possible for a member to receive covered services from an out-of-network dentist and be reimbursed at the same benefit level as if the covered services were provided by an in-network dentist. If this situation occurs, the member should call customer service to discuss options prior to visiting the out-of-network dentist.
- Customer service for individual plans: 800-971-4108 (TTY users call 711)
- Customer service for group plans: 800-524-0149 (TTY users call 711)
If a member requires emergency treatment and receives covered services from an out-of-network dentist, covered services for the emergency care rendered during the course of the emergency will be treated as if they had been provided by an in-network dentist.