Self-paid dental insurance
Hi parents. My husband's employer provides us with Delta Dental USA, but they really do not have any pediatric dentists that are covered by our plan. (I just got off the phone with them and even their rep said they really didn't have anything.) Does anyone have a recommendation for a dental insurance plan that covers pediatric dentists in the Oakland/Berkeley area? Or area we better just paying out of pocket for this?
(I've looked through past posts, but all on this topi are form 10+ years ago.)
Apr 3, 2023
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If you have the option of choosing Delta Dental PPO instead of DeltaCare--some employers offer both, but the PPO costs more--they are in network for several local pediatric practices (including Uptown Pediatrics in Oakland, where our kids go). I've found the DeltaCare network pretty lousy in general. For a couple of years when we didn't have the PPO plan as an option, we just paid out of pocket and it was also pretty reasonable.
We used to have Delta and our pediatric dentist, who I LOVE, stopped accepting it on Jan 1. Around the same time, my husband’s company switched to Cigna for dental. Our pediatric dentist (Alameda Pediatric Dental) is also out of network but the coverage is actually still decent. For my daughter’s latest exam, cleaning, fluoride, and x-rays my total out of pocket was $17. I had to pay 20% upfront to the dentist and they refunded me the other $60 once they got paid by Cigna. Of course, the actual coverage you would have is determined by whatever plan you choose. But you might want to ask your dentist’s receptionist which insurance company they see offering the best coverage.
In my experience in taking my child to a "general dentist" for many years, starting at age 2, you do not need a pediatric dentist for child check ups and cleanings. A general dentist or a family dentist is fine. If the dentist determines your child has a condition that requires a dentist who is pediatric board certified, they will work with you on a referral.
My employer provides Delta Dental PPO, and an old dentist once told me that most dentists only accept this one. I don't know if it is available for private purchase
We have delta dental and my kids went to Aloha pediatric dentistry in Berkeley when we lived in Oakland. That was before Covid time. You can check with them to see if they still take it.
We also have Delta and our pediatric dentist (Alameda Pediatric Dentistry) just dropped them. We are now out of network but have continued to see them because Delta pays about 2/3 of the cost for most things. We may reevaluated once our kids need orthodontic work as that rate is lower. But for now the high level of care we get there and the pain of finding something new has kept us there.
The way it works is we pay the full cost up front (about $300) and then Delta reimburses us (about $200). The dentist does all the billing, which makes it easy. I know this isn't an option for everyone but it's worked for us so far. This might be cheaper for you than buying additional insurance.
A belated thank you for all these inputs! Good to know the difference between DeltaCare and Delta PPO. Though I don't think the PPO was an option for us through out employer, and since DeltaCare is network is so limited, the employer is in the process of changing this anyway. We probably will have to just pay out of pocket for this coverage gap..... we're looking at some of the dentists that offer the 1 year membership packages that include two visits. Thanks!