1. Please read insurance policy summary first.

2. Find out what happened to Delta Dental in 2023.

3. You may also want to read our deep dive into insurance too.

Types of Dental Insurance

Dental insurance comes in a few different flavors such as Traditional, PPO, HMO, and Union plans. There are also blended plans, subtypes, other variations, and finally some government sponsored types such as Medi-Cal or Denti-Cal. It's the PPO plan that is most worthy of discussion today because it's usually the most popular and best choice offered by employers.

In-network and Out-of-network

These terms describe a dentist's contractual status with a PPO plan provider. Being "in-network" means the dentist has entered into a contract with the insurance company and has agreed to accept a reduced reimbursement rate in exchange for a larger number of patients. This business model exerts pressure on the dentist to cut costs and increase speed to manage a higher volume of patients. This takes the focus off of you and your health and prioritizes finances and business instead.

Being "out-of-network" means the dentist does not accept the insurance company's rules and will not allow the insurance to influence policy or operation of the office or patient's healthcare. This keeps you and your health in the spotlight. Cutting out the middleman is a more direct way of cutting costs and increasing the quality of service.

When "out-of-network," most insurance plans (as long as they're good quality group plans) pay out higher reimbursements. This eliminates the pressure to "cut corners" that in-network plans exert on the office. This means the dentist has the freedom to be more generous with time, offer higher quality services, and use the best materials.

In the case of biological dentistry, choosing the highest quality, most biocompatible materials is paramount to healthy dentistry. None of this could be done with "in-network" restrictions.

Specific Plans

Delta negotiates and sells a specific plan to your employer. Some of these plans are high quality and pay high reimbursement rates (so you'll have less, little, or none to pay). Some of these plans are "cheap" and pay very reduced rates. If you feel like your Delta plan used to offer better coverage in 2022 and now has reduced coverage in 2023, you may file a grievance with Delta. (Most other well-known providers provide good coverage when out-of-network.)

For example: If you work for a very large and profitable biotech company, they can generally afford to buy a better quality Delta plan. When billed out of network, this Delta plan will likely pay 100% of whatever reasonable fees are charged for preventive procedures (check-ups, x-rays, cleanings). You'll have 100% coverage for great quality care.

But if you work for a small company with just a few hundred employees, your employer may not be able to afford a good Delta plan. They likely chose a lower tier plan. On the surface, Delta sounds like Delta, and you might not know there is a difference. But when billed out of network, there is a significant difference between a "good" Delta plan and a "cheap" one.

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Although more and more dentists are being forced out-of-network, it was still a difficult decision that we put off for a very long time. However recent pressures from Delta were unbearable without making the switch to out-of-network status. Our primary goal is to deliver high quality healthcare while keeping costs down. By remaining out-of-network, we can continue to do both.