How Does DeltaCare Work?

DeltaCare® USA is the National Dental Care Organization (DHMO) of Delta Dental. They have a managed care plan that is able to provide good quality care for a fraction of the cost of traditional plans.

We will see how their plan works and focuses on prevention, on their level of service and the quality of their provider network. More importantly, we will discuss their benefits and the savings you could accumulate using their innovative dental plans.

The whole philosophy of prevention is at the heart of their approach to managing your dental care. There are more than 120 diseases or conditions directly related to oral hygiene. Therefore, DeltaCare offers its members full coverage for preventive services and examinations. The goal is to keep their patients in good oral health and thus prevent future costly or serious problems before they start.

How it works?

DeltaCare works a lot like a dental HMO. As a DeltaCare member, you select a Primary Care Dentist (PCD) from its network. Your regular dentist will organize your treatment plan after you have been examined.

If you need specialist care, you can choose a specialist from the DeltaCare network or visit your primary care dentist for a recommendation. You will be responsible for the co-payment for most of the procedures you receive. You pay directly at the dentist to your dentist. You don’t have to file any insurance claims or forms at all. This is one way of making the process easier to manage. You also have the advantage of knowing before you go what your costs will be because the co-payments are fixed and published.

The benefits of this type of managed care program are numerous. Standard benefits include full coverage for exams and cleanings and preventative services. In addition, another standard benefit is full orthodontic coverage. (This is unusual compared to what most other companies offer.) A group plan can be set up if you have more than 5 employees and it will include prevention and varying levels of restorative dental care. We have already mentioned the fixed co-payments which list each procedure included and what the initial cost will be, so that you can be better prepared for dental costs.

Working with a large national company also gives you a comprehensive, high-quality network of professional dental providers. The savings you receive are in part attributable to the DeltaCare capitation plan. This means that each dentist in the network receives a lump sum each month to take care of you and all the other members. This is how the insurance company can manage its costs so effectively. It also encourages dentists to focus on prevention in order to minimize their own need for extensive and expensive treatment.

On the flip side, some critics oppose the capitation plan because it leaves the option for dentists to be paid for your membership, whether or not you have been treated in that particular month. Nevertheless, this type of plan has demonstrated the efficiency, effectiveness and quality of services and savings across the country. Plus, he has a satisfaction guarantee refund policy for all members of his DeltaCare dental plan.

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