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Treatment in progress

Coordinating more than one dental plan

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Finding a dentist

Seeing an in-network provider will save you money. The Delta Dental PPO Plus Premier™ network includes more than 152,000 providers nationwide.

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Your ID card

Printed ID cards are mailed to you. But you can also access your card whenever you need it. Just sign into your member account (after your benefits effective date).

Look around and find useful information about your dental benefits.

Explaining networks and why it matters

If you or someone on your plan are in the middle of dental work – like a crown or root canal – your provider will need to submit a claim to Delta Dental of Wisconsin under your new plan ID number. The dental office should submit your claim on the date the permanent crown was placed, or the date the root canal was completed.

Please note: In order for the treatment to be covered, your provider must be a Delta Dental network dentist. You can look them up in our Provider Search to check.

Crowns and root canals

Orthodontics

Orthodontic treatment is considered “in progress” if bands/appliances have been placed and the patient is actively being treated by a provider at the time coverage becomes effective. Your plan will make monthly payments for orthodontic treatments in progress for the months remaining on the treatment plan.

We know insurance can be confusing. Here are some topics we get asked about most often from people new to Delta Dental.

Get to know your plan

Explaining networks and why it matters

Coordinating more than one dental plan

Sometimes people have more than one dental plan (for instance: spouses each having dental coverage through their employers, or a child having coverage through both parents). This is called dual coverage and requires a coordination of benefits to process claims. There is a process we follow to decide which plan is considered primary, leaving the other plan…well…secondary.

Treatment in progress

Generally, coverage through your plan will pay primary for you. For children, the plan of the parent whose birthday comes first during the calendar year is designated as primary; the other parent’s plan is secondary. If you still have questions, here is more information on coordination of benefits.

Primary and secondary plans

Explaining networks and why it matters

Treatment in progress

Coordinating more than one dental plan

Explaining networks and why it matters

Resources

There's more benefits to your Delta Dental plan than you might expect. Here are some member perks to keep in mind.

Give the receptionist your ID card. If you don't have your ID card, be sure to tell them you are covered with Delta Dental of Wisconsin.

You will receive an Explanation of Benefits (EOB) that will outline what your provider charged, what amount is allowed, and how much Delta Dental will cover for the services. This is not a bill.

If you are responsible for a portion of your services, a bill will come from your dentist’s office once the claim has been processed.

Save on paper – once your benefits are active, you can request EOB statements get sent to your email. Sign into your member account to update your preferences.

Schedule your appointments early, as they can fill up fast!

Calculate what some treatments might cost with our cost estimator.

Check your online account to verify benefit levels, annual maximums, deductibles and more.

Before an appointment

Let the dentist know about any medications you are taking, or possible issues you are experiencing.

Don’t forget to schedule your next appointment.

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After your visit

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Delta Dental of Wisconsin

Create your account

Get the most out of your coverage with an online account.

You can register any time after your coverage is active. All you need is your ID number found on the card sent in the mail. Once signed in, you can view claims information and activity on the dashboard, customize communication preferences, view explanation of benefits (EOBs), and more.

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Dental insurance terms

Does any of this having you asking, “But what does that MEAN?”

Our glossary of terms can help with insurance jargon and dental services terminology.

VIEW GLOSSARY OF TERMS

Why are my benefits through Delta Dental of Wisconsin?

Coordinating more than one dental plan

Treatment in progress

Why are my benefits through Delta Dental of Wisconsin?

Coordinating more than one dental plan

Treatment in progress

Explaining networks and why it matters

Treatment in progress

Coordinating more than one dental plan

grin! magazine

Blog

Oral health topics

My Dental Score

Document library

CHAT WITH US

EMAIL US

You know the drill. Send your message to claims@deltadentalwi.com.

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Phone

Great people in Wisconsin are ready to answer your questions. 800-236-3712

SEE QUALIFYING CONDITIONS

People with certain health conditions can benefit from extra dental care.**

Additional Benefits

LEARN MORE ABOUT CHECKUP PLUS

The cost of regular checkups and cleanings don’t count toward your annual maximum.**

CheckUp Plus™

See qualifying conditions

Learn more about CheckUp Plus

LEARN MORE ABOUT CHECKUP PLUS

Learn more about Amplifon

A discount hearing program through Amplifon included with your dental benefits.

Hearing Benefits

LEARN MORE ABOUT CHECKUP PLUS

Learn about virtual visits

Virtual dental visits are covered under your dental plan.

Teledentistry

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Delta Dental of Wisconsin

Here’s more info on managing treatments in progress. Please note: You can see any provider you like.* However, you’ll save money if you see an in-network provider. You can look them up in our provider search to check.

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Select a topic for information about how to use your benefits.

For more complex services, get a predetermination of benefits from your dentist.

Ask your dentist if extra services through our Evidence-Based Integrated Care Plan would be beneficial to you.

Networks were created to save you money when you see the dentist. And our Delta Dental PPO Plus Premier™ network has the most providers of any insurer. Our dentists agree to lower their fees for Delta Dental members, so it will benefit you most to see an in-network provider.

We technically have two networks: PPO and Premier.

Two networks to choose from

Even if you live in a different state, your benefits are through Delta Dental of Wisconsin because your employer is most likely located in Wisconsin. Delta Dental is a nationwide organization with local member companies in multiple different states. Typically, wherever your employer is located is the Delta Dental state that will administer your benefits.

Finding a dentist in your state

Don’t worry, our network has the most dentists nationwide which means you can still see an in-network dentist in your state. You can find one near you using our provider search.

**Not included on all plans. Review your benefits plan information or sign in to your Member Portal to verify coverage.

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PPO providers agree to the largest discounts, saving you the most money. Premier providers offer slightly smaller discounts, but there are additional dentists to choose from.

No matter which network you choose, you will still be saving money off retail. And there are other added benefits like treatment guarantees and claims being sent in for you (so you don’t have to worry about paperwork or getting reimbursed). Want to see if your dentist is in-network?* Our provider search can help.

*Plan coverage may vary based on network type. Please refer to your plan documents for benefits information.

*Some plans may not offer out-of-network coverage. Please refer to your plan documents for benefits information.

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*Plan coverage may vary based on network type. Please refer to your plan documents for benefits information.

Frequently asked questions – managing treatments in progress

Delta Dental of Wisconsin

Members

Delta Dental wants to ensure a smooth transition to your new dental benefits. If you or a family member are currently undergoing a dental treatment that began prior to your Delta Dental coverage, the information below will help coordinate your continued care and coverage.

Will I, or my family, need to change providers?

You can see any provider you like. However, you’ll save money if you see an in-network provider. The Delta Dental PPO Plus PremierTM Network includes more than 150,000 providers nationwide. To see if your existing provider is in our network, visit deltadentalwi.com.

The provider should submit the claim with the date the completed crown is placed in your mouth, or when root canal treatment is completed. The claim should be submitted to Delta Dental of Wisconsin with your plan ID number.

What if my provider has started work on a crown or root canal?

Treatment is considered “in progress” if bands/appliance have been placed and the patient is actively being treated by a provider at the time Delta Dental coverage becomes effective. Delta Dental will make monthly payments for orthodontic treatments in progress for the months remaining on the treatment plan. Example: A 30-month treatment plan, minus 12 months completed as of the effective date of coverage equals 18 months of treatment remaining. The new Delta Dental benefit is payable for up to 18 months at the coinsurance percentage up to the orthodontic maximum.

Orthodontic treatments

Please ask the provider’s office to send a new claim to Delta Dental with your plan ID number after your plan’s effective date. Orthodontic monthly benefit payments will be issued after eligibility has been verified. The claim should include these treatment details: Date active treatment began (date current appliance or bands/brackets were placed) Total fee for the active treatment plan ADA CDT procedure code for the treatment plan Total number of months the active treatment plan is expected to last

How will Delta Dental know if an individual is in an active orthodontic treatment plan?

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Coordination of Benefits (COB)

Delta Dental of Wisconsin

Members

It’s not uncommon for an individual to be covered by two dental plans. This often occurs in situations where both spouses are employed at workplaces that offer dental plans. When a person is covered by more than one dental plan, there needs to be a coordination of benefits when the claim is processed. The first determination is which plan is primary. Generally, the member’s plan will be primary for them and their spouse’s plan will be primary for the spouse. If a member has children, usually the plan of the parent whose birthday comes first during the calendar year is designated as primary; the other parent’s plan is secondary. (For children in blended families, the rules can be more complicated. Check your plan policy for details about order of benefits in specific circumstances.)

Most plans utilize a Traditional Coordination of Benefits. After benefits have been determined under the primary plan, the secondary plan will determine its allowable benefit and pay a benefit up to the full amount of the claim. See examples below. Occasionally, the secondary plan has a Non-Duplication Coordination of Benefits. In these cases, it will not “duplicate” benefits that were paid by the primary plan. See examples below. Plans with traditional coordination of benefits are much more common than those with non-duplication. However, as shown in the chart below, the difference can have a significant impact on your out-of-pocket costs. Members may check with their employer’s Human Resources department to see which type of coordination of benefits is used in each plan.

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Duplication of benefits

Examples

Allowable charges of $130 with services covered at 80% by both the primary plan and the secondary plan.

Allowable charges of $1,600 with services covered at 50% by the primary plan and 80% by the secondary plan.

Allowable charges of $4,000, with services covered at 50% by both the primary plan and the secondary plan. The primary plan has a $1,200 maximum, and secondary plan has a $1,500 maximum.

Primary plan pays

Secondary plan pays

You pay

Secondary plan pays

You pay

Traditional COB

Non-Duplication COB

$104

$800

$1,200

$26

$800

$1,500

$1,300

$480

$300

$26

$320

$2,500

Note: These examples are for purposes of illustration only. They do not consider deductibles, exclusions, specific contract language, and other factors that may apply in the processing of claims under real-life circumstances.

Delta Dental of Wisconsin

Primary plan pays

Secondary plan pays

You pay

Traditional COB

Secondary plan pays

You pay

Non-Duplication COB

Primary plan pays

Secondary plan pays

You pay

Traditional COB

Secondary plan pays

You pay

Non-Duplication COB

Smarter dental plans

Delta Dental of Wisconsin

Members

Our CheckUp Plus™ plan option allows members to get diagnostic and preventive dental services without those costs getting applied to the individual annual maximum. Preventive care saves money over the long-term by reducing the need for more expensive services. CheckUp Plus™ lets you keep your annual maximum for the things you need, not the things you deserve. The charts show the impact of CheckUp Plus™ on an individual annual maximum compared to a traditional plan. Example assumes two routine check-ups, covered at 100% and a $1,000 annual maximum.

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CheckUp Plus™

Delta Dental pays

Member pays

Maximum remaining

CheckUp Plus

$300

$1,000

Plan benefit and dentist charges vary.

$300

$700

Traditional dental plan

*CheckUp Plus must be included with your dental plan to qualify. Access your online account or review your benefits plan information to see if CheckUp Plus is included.

Delta Dental of Wisconsin

Predetermination of Benefits (PreD)

Delta Dental of Wisconsin

Members

After examination, your dentist may recommend treatment to be performed. Ask your dprovider to send the treatment plan along with any supporting documentation they may have including applicable radiographs (X-rays), narratives, clinical notes, etc. to Delta Dental if the services involve the following: crowns implants fixed bridgework partial or complete dentures other extensive restorative work The available coverage will be calculated and printed on a Predetermination of Benefits form which will be sent to you and your dentist. The form is valid for one year from the date issued. You can also view it by signing in to the Member Portal. Discuss with your dentist your patient responsibility and the amount to be paid by Delta Dental before you schedule dental treatment appointments. Delta Dental encourages you to use this service. If you have any questions about a predetermination, call 800-236-3712.

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Delta Dental of Wisconsin