Whether you’re a new employee of Atlantic Health or a seasoned veteran, you’ve probably had experience with their dental plan. Dubbed SmileCare and SmileCare Plus, both plans are PPO plans from Delta Dental of NJ. PPO plans let you have your choice between in-network dentists as well as out-of-network dentists. The funny part about both SmileCare plans is that they really try to force you to choose an in-network provider by only covering 50% of your cleaning and exam if you see an out-of-network dentist. With so many dentists who are part of the Delta Dental network, why would anyone choose to go out-of-network? Well, we are out-of-network, and we still have plenty of patients that use their SmileCare benefits at our office. Whaaaaaat? Keep reading to find out why they would do such a thing…
The truth about 50% out-of-network benefits
With SmileCare, for a typical new patient cleaning, exam, X-rays, we will get paid a little less than $200 by Delta Dental for your visit. The explanation of benefits from Delta Dental says we are supposed to charge you around $300 as a copay. That’s crazy! They paid 50% of their PPO fee for the visit. In essence, Delta Dental and Atlantic Health are saying, if you choose to see someone out-of-network, we’re going to pay them even less than someone in-network! Ha!
That’s not fair for you, since PPO plans are supposed to let you choose any dentist you’d like. That’s why at our office, we take that 50% payment as payment in full. Yes, you read that correctly. We won’t bill you for the rest. Why? Because nobody should force you to see a dentist that you may not want to see. We want the superior care we provide to be available to everyone.
So now that we know about out-of-network benefits, what about my maximum, deductible, and other benefits?
SmileCare and SmileCare Plus both have $50 deductibles for each calendar year, which is the standard. They both have the same benefits for basic and major treatment (80% and 50%, respectively). The only difference I can see is that SmileCare Plus provides some orthodontic benefits. They say that they’ll pay up to 50% of orthodontic treatment (up to $2,000) per dependent up to the 19th birthday.
Here is something you might now know. Both of Delta Dental’s SmileCare and SmileCare Plus policies cover unlimited exams and dental cleanings. If you have had a few cavities and aren’t great at flossing, come to the dentist 3 times a year instead of twice! Do you love that just-cleaned feeling after a visit? Come four times a year! Want to be my best friend – come once a month for a cleaning! No, I’m just kidding. The same policy actually applies to exams as well, which is nice, since most plans only cover two exams a year, and if you have a toothache or some other issue, the third exam in a year isn’t usually covered.
TLDR – If you have Delta Dental through Atlantic Health aka the SmileCare or SmileCare Plus plan, you will not have a copay for your cleaning, exam, and X-rays, even if you come to our out-of-network office.