Why did you decide to become an out-of-network provider for Delta Dental?

We understand that finding a dental provider that meets your needs is very important, and this is a difficult, but necessary decision for our practice to continue to provide the comprehensive care you deserve.

Our office has been a Delta Dental in-network Premier provider for over 20 years, however Delta Dental has not raised their reimbursement rates for Delta Premier providers since 2010, and their reimbursement rates are now well below (30-60% less) current average market rates.  

Given the rate of inflation over the past 10+ years with no fee adjustment from Delta Dental, the dollar of reimbursement in 2010 is now worth ~40% less, while the cost of materials, equipment and labor have risen at least that amount in the same time period.  This trend is not sustainable for us and in January 2023, Delta Dental changed their fee schedule which resulted in a further net reduction in the fee reimbursement rates for all Delta Dental Providers.

This move is not in line with our practice philosophy and belief that our patients deserve the very best. We are unwilling to use inferior equipment and materials, not invest in continuing education and our staff which ultimately impacts the quality of care as an in-network Delta Dental provider. Due to these increasing limitations, our office has made the difficult decision to transition from being an in-network to an out-of-network provider for Delta Dental Insurance. This will become effective on date: June 1, 2023.

Will I still be able to come to your office if I have Delta Dental and use my insurance benefits?

Yes.  All patients that have Delta Dental have out of network benefits that you can still use and maximize for your dental care at our office.

Will you still be able to process my insurance claims for me?

Yes.  As a service and benefit to you, we will gladly process and follow up with any of your Delta Dental claims.  If you prefer to send out the claims yourself, please let us know and we can help provide all the information you need to process your claim.

Will you still be able to pre-authorize proposed treatment through Delta Dental? 

Yes.  As a service and benefit to you, we will gladly send out pre-authorizations for proposed treatment to Delta Dental to help you better understand your insurance benefits/coverage and any out of pocket expenses you may have for services provided at our office.  Please keep in mind that these pre-authorizations, even if approved by Delta Dental, do not guarantee payment of claims and are subject to plan maximums and plan limitations. 

How will my office visit differ from before?

Now at the end of your service, you will receive an itemized breakdown for the services provided and you will be responsible for the full payment at the time of service. Since we will be out of network, Delta Dental will reimburse you directly and checks will be sent to you and not to our office. 

How much will it cost per visit now?

You will receive an estimate for all treatment proposed for your upcoming visit.  We can still check with Delta Dental to provide an estimated reimbursement for you.  Please keep in mind that this estimate is not a guarantee of payment.  Delta Dental has informed us that they will be sending reimbursement checks directly to the patient and not to our office.

Are you in-network with any other insurance companies?

We are not contracted with any insurance companies as we do not want to be limited in the quality of care we can provide our patients.  Our focus is on delivering the highest quality dental care and truly exceptional patient experience.

Am I able to change my insurance to a non Delta Dental plan?

It is best to contact your HR department or employer to request a change from Delta Dental.  Alternate plans may be available to you, and other insurance plans offered may have better out of network reimbursement than Delta Dental.  Consider increasing FSA/HSA savings as gap coverage between your Delta Dental out of network benefits and any out of pocket costs incurred.  

Do you offer an in house insurance plan as an alternative to plans that may be provided by my employer?

Yes.  We offer an in-house insurance plan for our loyal patients that may be more affordable than what your employer is offering.  If you are interested, you can always contact us at info@dentalcenteratherton.com or call us at 650-474-0551 for more information.

Are other dentists in the area impacted and dropping Delta Dental?

Yes.  Many of my colleagues have already dropped or are planning to drop Delta Dental due to the same limitations and constraints. 

What is the California Dental Association doing about this?

The California Dental Association has filed a lawsuit against Delta Dental on behalf of participating Delta Dental providers.  Unfortunately, we have been forewarned that this may take many years of litigation and will likely result in little to no change for Delta Dental providers.