How Does DeltaCare Work?

DeltaCareĀ® USA is Delta Dental’s national Dental Health Maintenance Organization (DHMO). They have a managed care plan that is capable of delivering fine quality care for a mere fraction of what traditional plans cost.

We will take a look at how their plan works and focuses on prevention, on their level of service and quality of their provider network. Most important we will discuss their advantages and the savings you might accumulate by using their innovative dental plans.

The entire philosophy of prevention is central to their approach to managing your dental care. There are over 120 diseases or conditions that are directly related to oral hygiene. Therefore DeltaCare gives its members total coverage for preventive services and for examinations. The goal is to keep their patients in a condition of good oral health and thus prevent future costly or serious problems before they begin.

How does it work?

DeltaCare operates a lot like a dental HMO. As a DeltaCare member you select a Primary Care Dentist (PCD) from their network. This will be your regular dentist who will organize your treatment plan once you have been examined.

If you need specialized care, you can choose a specialist from the DeltaCare network or consult with your Primary Care Dentist for a recommendation. You will be responsible for set co-pays for most of the procedures you receive. You pay right at the dentist office to your dentist. You do not have to file any claims or insurance forms at all. That is one way they keep the process easier for you to manage. You also have the benefit of knowing before you go what your costs will be because the co-payments are fixed and published.

There are many advantages with this kind of managed care program. Among the standard benefits you will find total coverage for examinations and cleanings and preventive services. In addition, another standard benefit is comprehensive orthodontic coverage. (That 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 various levels of restorative dental care. We have already mentioned the fixed co-payments that list every procedure that is included and what the up-front cost will be, so you can be better prepared for dental expenses.

Working with a large national company also gives you a comprehensive high quality network of professional dental care providers. The savings you receive are in part because of the DeltaCare capitation plan. That means each dentist in the network gets paid a flat fee every month to provide care for you and all other members. That is how the insurance company is able to manage their costs so effectively. It also gives the dentists encouragement to focus on prevention to keep their own need for extensive and expensive treatments to a minimum.

On the flip side, there are some critics who object to the capitation plan because it leaves room for dentists to be paid for your membership regardless of whether you were treated during that particular month. Nonetheless, this type of plan has demonstrated efficiency, efficacy and quality service and savings across the nation. Plus it has a guaranteed satisfaction refund policy for all of its DeltaCare dental plan members.

Source by Carin Nightingale