When is a dentist required to accept Delta Dental’s allowances? When can a dentist balance bill?
Balance billing occurs when a dentist bills you for the difference between the dentist’s actual charge and the amount benefited by Delta Dental for the service. Delta Dental’s participating dentists are prohibited from balance billing. They agree to accept Delta Dental’s allowances or their fees – whichever is less (the Allowed Amount) – as payment in full. The Allowed Amount is the maximum amount that a participating dentist can charge for a covered service. Delta Dental pays a portion of the Allowed Amount. You are responsible for paying the difference between Delta Dental’s payment and the Allowed Amount. Participating dentists are paid directly by Delta Dental, and by agreement cannot bill you more than the applicable copayment or deductible for covered services. You also may be responsible for charges that exceed your annual benefit maximum or for services that are not covered benefits.
