What is Delta Dental PPOSM (Point-of-Service)?
Delta Dental PPO (Point-of-Service) is Delta Dental’s national preferred provider organization program that gives you access to two of the nation’s largest networks of participating dentists—our Delta Dental PPO network and our Delta Dental Premier® network. Although you can go to any licensed dentist anywhere, your out-of-pocket costs are likely to be lower if you go to a dentist who participates in one of these networks.

Nationwide, more than 72,000 dentists participate in Delta Dental PPO, and more than 132,000 dentists participate in Delta Dental Premier.

What are the advantages of choosing a Delta Dental PPO dentist?
You will receive the highest level of coverage for some services when you go to a Delta Dental PPO participating dentist. In addition, Delta Dental pays their PPO dentists directly for covered services based on submitted fees or the amount in the local Delta Dental PPO fee schedule, whichever is less. If the Delta Dental PPO fee schedule amount is lower than the dentist’s submitted fee, the dentist cannot charge you the difference. This means you will be responsible only for your copayments and deductible, if any, when you go to a Delta Dental PPO dentist for covered services. Delta Dental PPO dentists will also fill out and file your claim forms, which means fewer hassles for you.

What are the advantages of choosing a Delta Dental Premier dentist?
Although you will receive a lower level of coverage for some services when you go to a Delta Dental Premier dentist, Delta Dental will pay the participating dentist directly for covered services based on submitted fees or the local Delta Dental maximum approved fee, whichever is less. If the maximum approved fee is lower than the dentist’s submitted fee, the dentist cannot charge you the difference.

As with Delta Dental PPO dentists, this means you will be responsible only for your copayments and deductible, if any, when you go to a Delta Dental Premier dentist for covered services. And, like Delta Dental PPO dentists, Delta Dental Premier dentists will fill out and file your claim forms for you.

How can I find a participating dentist?
To get the names of participating dentists near you, call Delta Dental’s Customer Service department at (800) 971-4108. Our DASI (Delta Dental’s Automated Service Inquiry) system is available 24/7, and can provide you with the names of participating dentists near you. You can also visit our Web site at www.deltadentalmi.com.

What if I go to a nonparticipating dentist?
If you go to a dentist who does not participate in Delta Dental PPO or Delta Dental Premier, you will still be covered, but you may have to pay more. We will pay you directly for covered services based on the dentist’s submitted fee or the local Delta Dental’s nonparticipating dentist fee, whichever is less. You will be responsible for paying the dentist whatever he or she charges. You may also have to submit your own claims.

Do I need to tell my dentist my coverage has changed?
Yes, it would be helpful if you told your dentist that you have Delta Dental PPO (Point-of-Service) coverage through Delta Dental of Michigan.

Do I need an ID card to receive care?
No. Your dentist can verify your eligibility for coverage 24/7 by checking our online Dental Office Toolkit® or by calling our DASI (Delta Dental’s Automated Service Inquiry) system. If you would like an ID card for reference purposes, you can use our online Consumer Toolkit® (www.deltadentalmi.com) to print one.

What if I have other questions?
Please call Delta Dental’s Customer Service department at (800) 971-4108. Our DASI system is available 24/7 and can answer many of your questions. DASI can provide you with benefit, claims, and eligibility information, our mailing address, and the names of participating dentists near you. In addition, Customer Service representatives are available to assist you Monday through Friday from 8:00 a.m. to 6:00 p.m. EST.

You can also use our Web-based Consumer Toolkit to access your own benefit, claims, and eligibility information 24/7. You can use this Toolkit to search our dentist directories, print ID cards and claim forms, sign up for paperless delivery of your Explanation of Benefit (EOB) statements, and read oral health tips.