Notice
Change Healthcare announced a breach of HIPAA privacy and is reaching out to individuals whose personal information may have been compromised. Although this incident does not involve Delta Dental of New Jersey or Connecticut, Change Healthcare is a vendor we used and we are providing this information to help our members who might be affected.
Changes to certain dental specialist claims beginning in 2022
Please review the following message from Delta Dental on how claims from certain specialists will be impacted in 2022 and how to get the most out of your dental benefits.
Note: not all employees are affected by this change, as detailed below.
What is changing:
On or after January 1, 2022, you may see a change in your out-of-pocket costs when utilizing participating Delta Dental Premier-only specialists, such as endodontists, periodontists, prosthodontists, oral surgeons, and orthodontists.
Currently, if you visit a participating specialist (PPO or Premier), regardless of your plan and the networks included, approved procedures are covered in-network with no balance billing.
After January 1, 2022, impacted members will be responsible for:
- the difference between the PPO-approved specialist charge and the Premier network-approved charge, in addition to
- our applicable deductible and coinsurance, and
- any amount in excess of your plan maximum.
You will be impacted only if you are:
- from New Jersey or Connecticut and see a Premier-only specialist, AND
- are enrolled in
- a plan that includes the PPO network only, or
- a PPO Plus Premier plan that has a different coinsurance amount when using a PPO dentist (also known as a steerage plan)
How will my ongoing treatment with a Premier-only specialist affect my out-of-pocket costs?
In the case of orthodontics, you will not be impacted if you are:
- an eligible patient who completed a pre-orthodontic visit before January 1, 2022, and/or
- a patient in orthodontic treatment started before January 1, 2022 who is using a Premier-only orthodontist.
If you are an eligible patient who had a pre-orthodontic visit or ortho treatment started on or after January 1, 2022, you will pay the difference between the PPO-approved specialist charge and the Premier network-approved charge, in addition to any coinsurance and applicable deductible.
If you continue to see any other Premier-only specialist, you will pay the difference between the PPO-approved specialist charge and the Premier network-approved charge, in addition to any coinsurance and applicable deductible.
How can I avoid potential additional out-of-pocket costs?
You can best maximize your benefits and pay the least out-of-pocket when using a participating Delta Dental PPO dentist. You can find PPO dentists using our Find a Dentist tool. They are identified by the “Greater Savings” logo.You should check the Find a Dentist tool when seeking the best discount for their dental care starting January 1, 2022. Choosing providers without this logo will result in additional patient out-of-pocket costs.
Thank you for entrusting your oral health with Delta Dental. If you have any questions on this topic, please contact the customer service number on your ID card or 1-800-452-9310.
Delta Dental of New Jersey is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.
