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Delta Dental of Arizona has developed an effective cost management strategy exclusive to Delta Dental of Arizona. The Delta Dental Difference is designed to eliminate exposure to unplanned costs for both enrollees and groups by providing guaranteed benefit for enrollees and documented savings for groups.
The Delta Dental Difference truly sets Delta Dental of Arizona apart.
- Extensive Networks
Four out of five Arizona dentists have contractually agreed to provide our groups and subscribers with valuable cost and quality assurances.
To encourage better oral health through timely preventive care, employees are free to choose any dentist they wish. However, they enjoy the best possible benefits of their plan and lower out-of-pocket expenses when they select a dentist who is a member of a Delta Dental of Arizona network.
- Dentist Fee Database
As the largest dental benefits company in Arizona and a member of the Delta Dental Plans Association, the largest dental benefits provider nationwide, Delta Dental has the most comprehensive and up-to-date database of dentist billed charges. This database is a key component in establishing an effective Maximum Plan Allowance payment schedule.
- Specialized Claims Processing
To ensure that The Delta Dental Difference is administered uniformly, Delta Dental uses a sophisticated computerized processing system designed specifically for dental claims management. The program uses more than 300 automated cross-checks when reviewing a claim. For example, the system verifies:
- the patient's dental history
- a dentist's status as a member of a Delta Dental of Arizona network
- possible duplication of services
- payment only for the completed dental procedure
- coordination of benefits where other health or dental coverages may apply
This careful attention to detail and a thorough working knowledge of dental practices are essential for proper plan administration. They make it possible for claims payments to accurately reflect the level of benefits purchased and prevent unwarranted charges.
- No Balance-Billing (Guaranteed Benefits)
The Delta Dental of Arizona patient will be responsible only for deductibles, copayments, and services not covered. Any amount that exceeds the fee allowed by Delta Dental of Arizona will not be chargeable to the patient.
In addition, protection from inappropriate billing is guaranteed when subscribers use a network dentist. For example, member dentists agree that charges for the following services will not be billed to the patient:
- Repair or replace dental restorations or dental sealants that fail within 24 months
- Local anesthesia as part of a dental procedure
- For multiple x-rays (periapicals, bitewings, and/or panoramic) itemized separately: payment will be based on one complete series
- In-Office Fee Audits
Periodically, Delta Dental of Arizona will audit network dentists to ensure that charges to Delta Dental of Arizona patients are the usual charges, the services billed were actually performed, and that no contractual violations such as forgiveness of copayments have occurred.
- Dental Case Management
To ensure that treatment meets professional standards of dental care, network dentists agree to abide by and cooperate with findings of dental consultants and peer reviews. To discourage overutilization, dentists also agree to cooperate fully with impartial utilization review programs that identify practices where treatment and costs fall outside carefully developed norms.
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