Delta Dental Representatives Address MEA Board Member Concerns
Delta Dental representatives were invited to attend MEA’s Board meeting on August 11th. The purpose of Delta’s participation was to hear from the Board regarding members’ concerns with the DeltaCare® USA DHMO plan. Issues that were discussed included certain Delta DHMO dentists who might not be adhering to the SDMEA DeltaCare 10A copay schedule, some providers not offering lower cost covered procedures and several inconsistent responses from DeltaCare Customer Service. During the meeting, the Delta Team responded to the Board’s questions and made a commitment to address MEA concerns and to establish an open line of communication between members and DeltaCare.
The following information was one of the topics discussed at MEA’s Board meeting and better explains the DHMO program and treatment plans. We hope that you will find this information useful, and we look forward to finding opportunities to better serve you.
As always, if you have questions regarding any of your MEA-sponsored benefits, please contact MEA Benefits Coordinator Jon Hayes at 888.217.9175.
Your DeltaCare® USA DHMO Program and Treatment Plans
How to use the DeltaCare program:
When you enrolled in the DeltaCare program, you selected a contract dentist from the list of dental facilities available online or on the provider directory. If you did not select a dentist, one was assigned to you.
Following your enrollment in DeltaCare, you received a packet containing the following:
• An ID card
• An Evidence of Coverage booklet with a complete list of covered procedures, copayments, plan limitations and exclusions
• The name, address and phone number of your DeltaCare dentist
To make an appointment, simply call the dental office and identify yourself as an enrollee in the DeltaCare program. DeltaCare will notify your contract dentist about your plan enrollment and provide any other important information about your coverage, such as dependent information, group number and enrollee ID number.
You must go to your assigned dentist to obtain covered services, except for specialists’ services pre-authorized (in writing) by DeltaCare or for emergency services. When you visit your assigned dentist, you are responsible for the applicable copayments for covered benefits listed in your Evidence of Coverage booklet. Procedures not listed in the booklet are considered non-covered services and are subject to the dentist’s customary and reasonable fees. With DeltaCare, there are never any deductibles, lifetime maximums or claim forms.
Treatment provided by an out-of-network dentist is not covered under this program.
Questions about your plan:
If you have questions or would like to check your benefits and eligibility information, please go to Delta Dental’s website at www.deltadentalins.com You are also encouraged to contact DeltaCare by e-mail or call one of DeltaCare’s Customer Service representatives toll-free during business hours at 800-422-4234.
On the website, you can:
• Find a dentist with the online directory
• Review benefits
• Verify eligibility
• Print an ID card
To access certain services, you will be required to log in. To do so, simply enter your user name and password in the designated boxes. If you are visiting the Delta website for the first time, you will need to complete a quick one-time registration process by clicking the “Register Today” link.
Talking to your dentist about your treatment options:
DeltaCare dentists are required to present you with an appropriate treatment plan containing an explanation of benefits and costs. Dentists must also present alternative treatment plans to their patients including covered and non-covered services. Under no circumstances may a DeltaCare dentist deny a patient services that are covered based on the patient’s refusal to accept optional or non-covered treatment(s). Prior to consenting to a treatment, please review your Evidence of Coverage booklet which details your benefits and co-payments before deciding on the treatment option that works for you. In addition, please ask your dentist to explain the pros and cons of each dental treatment option, including the future costs or consequences of postponing or avoiding treatment. Signing the accepted treatment plan ensures that both you and your dentist have a clear understanding of your treatment choice.
What if you only want a cleaning and your DeltaCare dentist will only offer other services?
Dental prophylaxis (cleaning) is rarely done at a first appointment and it is only done after a clinical exam is completed in order to determine the presence of gum disease. While prophylaxis removes plaque (tartar) and stains from teeth, it is performed only when the gum tissue is healthy or after the completion of any needed periodontal (gum) treatment(s).
What if your dentist advises you that you need a lot of work done and you were not aware of this through your prior dentist?
Dentistry is not an exact science. Dental professionals may have differing treatment modalities in order to treat any given case. You may request a second opinion if you disagree with, or question the diagnosis and/or treatment plan determination made by your assigned dentist. DeltaCare may also request that an enrollee obtain a second opinion to verify the necessity and appropriateness of dental treatment or the application of benefits. To request a second opinion, please contact the DeltaCare Customer Service Department at 800-422-4234.
Questions about quality of care
DeltaCare is committed to ensuring that our dentists provide you with quality dental care. One step in reaching this goal is to monitor each dentist’s quality of care performance and their compliance with stringent hygiene standards. If you have questions or concerns about your experience with a DeltaCare dentist, please call DeltaCare’s Customer Service line at 800-422-4234. Our representatives are committed to answering your questions and addressing any issue or concern you might have. They can also arrange facility transfers, urgent care referrals and assist with a treatment plan review.