There are three things we recommend you do before you go to your dentist appointment.
View your dental benefits
You can view your coverage by signing into MySmile® or reading your benefit booklet. Knowing what’s covered before you visit the dentist helps eliminate surprises at the office. See our Dental benefits explained guide to understand what you should look for.
Find an in-network dentist
In the dental insurance industry, we call in-network dentists “participating dentists.” We use this term because these dentists participate in a specific dental network. If you see this term in your benefits booklet, please know it’s the same as in-network dentists.
In-network dentists provide services at discounted rates for members of the plan which uses the network they participate in. It’s kind of like how you get special discounts for using a Kroger card at QFC and Fred Meyer. Membership rewards only apply at Kroger stores.
In-network dentists also file all of your claims paperwork for you.
If you see a non-participating, or out-of-network, dentist, you won’t receive dental services at the same discounted rate. You’re responsible for paying the dentist any amount above our allowed fee for that service. You’re also responsible for ensuring they complete claims forms and send them to us.
It’s easy to find an in-network dentist. Simply use our Find a dentist and be sure to select your plan’s network.
If you don’t know what network your plan uses, sign in to MySmile and use its Find a Dentist tool. It automatically selects your plan’s network so you don’t have to.
Get out-of-pocket dental cost estimates
We know it’s not always easy to figure out how much you’ll have to pay for dental services. We also know dental costs can sometimes be a barrier to treatment.
That’s why we created the MySmile Cost Genie®. It gives you instant, personalized out-of-pocket cost estimates based on your benefits and dentist. It’s a great way to see your dental costs for many different treatments.
Create or sign in to your MySmile account to estimate your dental costs.
There are four things we recommend you do at your dentist’s office.
First, tell the front office staff that you’re covered by Delta Dental of Washington and show them your member ID card.
Provide information on other dental coverage you may have
If you’re covered by more than one dental plan, your dentist’s office will help coordinate your coverage. Your dentist and dental plans will work together to make sure you get the most out of your dental benefits.
Tell your dentist’s office about both plans. We recommend bringing both of your ID cards so they can help coordinate your coverage.
Talk about your overall health
Research shows there’s a link between your oral and overall health. Tell your dentist about your health helps them provide better care for your mouth.
Talk to your dentist about:
- Heart disease
- Tobacco use
View our blog to learn more about the connection between oral and overall health.
Request a Predetermination when your dentist recommends treatment
If your dentist recommends extensive and possibly expensive treatment, we recommend you ask them to submit a Predetermination. Once submitted, you’ll receive a Confirmation of Treatment and Costs.
A Confirmation details your dentist’s specific treatment plan, what your benefits pay, and gives you an accurate out-of-pocket estimate. Many dentists are able to get Confirmations in real-time. If not, you can sign in to MySmile and choose to receive an email notification once it’s ready. Then, you’ll be able to view your Confirmation through your MySmile account. If you don’t have a MySmile account, you will have to wait for a paper statement via standard mail.
After your visit, sign in to MySmile and click “My dental activity” to review your Explanation of Benefits (EOB). If you don’t have a MySmile account, you’ll receive a paper copy via standard mail.
Your EOB tells you how much of your benefits were applied towards your treatment and how much you have left.
There are four things you should do when reviewing your EOB. They are:
Treatments listed on your EOB should match the ones you received and were billed for. If you notice any inconsistencies, talk to your dentist’s office. Sometimes the dentist has to modify your treatment plan. If you’re not satisfied that your EOB is correct, let us know.
Check your maximums and deductibles
This information is helpful if you need additional dental treatment. Use it to work with your dentist on scheduling so you don’t exceed your maximums for the year.
Compare other dental coverage (if applicable)
Use this information to compare to your other plan’s EOB and dentist’s bill. If you have other coverage that is primary and this is blank, talk to your dentist office. If there is a number here and you don’t think it’s right, give us a call.
Here’s a bonus tip: Save your EOBs. You’ll need them for itemized deductions on your taxes; proof of qualified medical expenses; as well as any HSA, FSA, and HRA reimbursement.