Important Update About Delta Dental PPO
For many years, our practice has proudly participated in Delta Dental’s network so we could continue to care for so many of you with whom we have built long-standing relationships. However, after careful evaluation, we have made the difficult decision to discontinue participation in Delta Dental’s PPO network.
We would like to explain why and, just as importantly, what this means for you.
Timing
First and foremost, we want you to know that these changes will not directly affect anyone until January 2027. We are beginning this process now and notifying everyone so there is plenty of time for communication, planning, and questions.
Second, it is very important that you have some background information so you can understand why this occurring and if these changes will affect you at all.
Understanding Delta Dental Plans
Delta Dental traditionally offers 3 plan levels:
PPO (which includes DeltaCare and some Medicare Advantage plans)
PPO + Premier
Premier
These plans are marketed as offering different levels of coverage, reimbursement, and flexibility:
PPO plans typically have lower premiums but more restricted networks, fewer covered procedures, and significantly lower than average reimbursement rates for providers.
PPO + Premier and Premier plans generally have higher premiums and are advertised as providing broader access and higher reimbursement levels.
On paper, this suggests that patients who pay more for Premier-level coverage should receive stronger financial support for their dental care.
However, there is a critical issue many patients are not aware of: when a dental office participates in multiple Delta Dental networks, Delta often reimburses the provider at the lowest contracted fee schedule, regardless of the patient’s plan tier. In practical terms, this means that even if you are paying for a higher-tier Premier plan, your dentist will be reimbursed as if you had the lower-tier PPO plan. The extra premium you pay does not translate into the level of support you might reasonably expect.
Reimbursement and Industry Practices
Most major dental insurance companies periodically renegotiate reimbursement rates with providers to account for inflation, rising costs, and changes in how care is delivered. While these increases are often modest, they at least acknowledge the economic realities of running a healthcare practice.
Delta Dental, however, has largely resisted meaningful adjustments to reimbursement rates. Many providers, including our practice, experienced significant fee reductions in the 2019–2020 period, with some procedures seeing cuts in the range of 20–30%, depending on the region and contract. These reductions occurred despite ongoing increases in premiums and no meaningful improvement in patient benefits.
What is especially concerning for patients are annual maximums have remained largely unchanged since the 1970s, even though the cost of care has increased dramatically over that time. At the same time, premiums have steadily increased, meaning patients are paying more each year for coverage that has effectively decreased in value.
Dental Insurance Is Not True Insurance
Dental “insurance” functions very differently from medical insurance. Medical insurance is designed to protect against catastrophic financial loss, and benefits generally scale with the level of need.
Dental plans, by contrast, operate more like prepaid benefit programs:
They typically have annual maximums, often around $1,000–$2,000.
Once that maximum is reached, coverage stops for the remainder of the year, to include insurance coverage for preventative appointments. This leaves patients with the potential for substantial out-of-pocket costs.
A “Nonprofit” in Name
Delta Dental operates as a nonprofit organization, but that designation does not automatically translate into lower costs or greater fairness for patients or providers. Public filings from various Delta Dental entities report executive compensation in the millions of dollars annually, even as reimbursement to providers stagnates or declines.
This raises fair questions:
How are patient premiums being used?
Are the current structures truly aligned with patient care and provider sustainability?
The Reality of Running a Practice Today
Over the past 6–8 years, the cost of operating a dental practice has increased dramatically—by roughly 50% in our case. The largest portion of that increase is payroll. We are committed to hiring and retaining highly trained, compassionate team members who just like everyone else, are facing rising cost of living.
Other expenses—supplies, equipment, lab fees, technology, and regulatory compliance—have also increased substantially.
When reimbursement rates remain flat or decrease while costs continue to rise, it becomes unsustainable. At some point, remaining in a particular network contract means providing care at a financial loss, which ultimately threatens the quality and availability of that care.
The Final Straw With Delta Dental PPO
Before making this decision, we contacted Delta Dental directly to discuss our concerns. We explained that treating Delta Dental PPO patients under the current fee schedule was no longer financially viable and asked whether there were options for improved reimbursement.
Delta Dental did respond with a revised fee schedule. Unfortunately, the results were deeply disappointing:
Fewer than 10% of procedure codes saw any increase at all.
Those increases averaged only about 1–3%.
Approximately 30% of procedure codes were reduced, with average cuts around 30%.
Accepting this “new” schedule would have resulted in even greater financial losses for our practice.
After more than 11 years of caring for nearly 3,000 Delta Dental patients, this response felt not only inadequate but dismissive of the value we provide and the realities we face as a small business and healthcare provider.
Ultimatly
We refuse to compromise on:
The time we spend with each patient
The materials, labs, and technology we use
The training and fair compensation of our team
The overall standard of care we deliver
What This Means for You What You Can Do Next?
First it would be a great help if you knew exactly which network tier you participate in. Delta Dental makes it difficult for us to know which patients have PPO versus Premier coverage, so please check your benefits documents or contact your HR department to find out which plan you have.
If you have PPO + Premier or Premier
Nothing will change. Your coverage will remain the same moving forward.
If you have PPO coverage, you have a few options:
Ask your HR department about upgrading coverage to PPO + Premier or Premier during open enrollment for 2027.
Ask whether your employer can consider a different dental carrier altogether.
WE accept most major carriers all of whom are much more reasonable to work with.
Keep your PPO plan and continue seeing us as an out-of-network patient.
In many cases, you will still have some coverage, but you may be responsible for the difference between Delta’s allowance and our usual fees. We pledge to protect you from this increase until Jan 2027, allowing you ample time to determine you best course of action.
Drop dental insurance coverage altogether and automatically be enrolled in our in house plan.
Each individual gets 2 cleanings a year and regular set of intra oral Bitewing Xrays for $290 annually and a 14% discount on most general dentistry procedures.
If you are some one who is very routine with your cleanings and don’t typically require much dental work this will likely save you significant money in the long term.
Lastly and least desirable from our perspective, Keep your PPO plan and seek an in-network provider elsewhere.
This breaks our heart but for some of you this may be the best option. Just a heads up you may have trouble finding organization who still accepts Delta PPO. We seem to have held on longer than most as nearly all offices have been forced to make this decision.
Moving Forward
We know this is not ideal, and we understand this may be frustrating. Our goal is to continue caring for you while being honest about the realities of today’s dental insurance system.