Hello,
This letter comes with sadness. My practice has been a Delta Dental provider for several decades. Over the years per our contract with Delta we could submit proposed fee increases once a year and they would allow or deny the increases. All doctors in the practice billed Delta through me, a Premier Provider.
By the Summer of this year my associates Dr. Carl Buchanon and Dr. Susanna Cheng will most likely be out of network with Delta Dental. I will still be in network with Delta Premier. If your coverage is Premier your child can see me. If your coverage is PPO only you can see me, but you will have to pay Delta Premier fees up front and will be reimbursed from Delta the PPO fees. If patients see Dr. Carl or Dr. Susanna they will have to pay up front the UCR (usual customary rate) fees and Delta will reimburse you the PPO fees.
In 2019 Delta changed their policies and made all dentist providers register with Delta. They were not allowed to choose between Premier or PPO status. They had to register for both. The PPO fees were less than the Premier fees, and if a patient’s coverage was Premier and PPO, Delta paid the PPO fees.
Here is an example of Delta fees:
Sealant – Premier pays $72 PPO pays $40
2 X-rays- Premier pays $58 PPO pays – $28
4 X-rays- Premier pays $77 PPO pays- $39
Composite (large white) filling, permanent tooth – Premier pays $342 PPO pays-$188
Exam, cleaning <14 years old, fluoride- Premier pays $193 PPO pays $119
We use all the same equipment, materials, supplies and give each child, gentle, patient, age appropriate treatment while maintaining a high standard of care. The PPO fees are not adequate and we do not want to cut corners because of an insurance company’s shortcomings.
The Delta Premier fees already reflect a negotiated discount lower than our UCR (usual customary rate). When these fees were negotiated it seemed like a good deal but over the years they have not increased the fees so it is increasingly hard to pay expenses.
Some Premier fees have not increased since 2010. I have called multiple times and written to try to get an increase but was told I am at the “maximum for my area”. I found out via an EOB a mother brought me from her former office in Berkeley (4 miles away) that they receive $84 for sealants from Delta Premier and we receive $72. What could be the difference between Oakland and Berkeley? I also saw that an office in Castro Valley gets $121 for cleanings >age 14 and we get $94. Again what is the reason Oakland gets less?
Since 2019 my rent has increased, I have raised my wonderful staff’s salaries, I pay for my staff’s health insurance which has increased every year, material and supplies increase and there are always needed repairs and service on our equipment.
In summary-
- We will process your claim through Delta Dental as an out-of-network provider. We will collect your payment in full at each visit, and they will reimburse you directly.
- The amount that you get reimbursed by Delta Dental will depend on your employer’s fee schedule with Delta Dental.
- It is your responsibility to know your dental coverage.
- When your children come in for their next appointments we can explain further in person.
We appreciate you trusting us with your family’s dental care needs and we look forward to continuing to help you for many years to come.
IF YOU HAVE QUESTIONS ABOUT YOUR COVERAGE PLEASE CALL DELTA DENTAL @ 888-335-8227
Sincerely,
Dr. Denise Bass Allen
