Question

I was reading our state law regarding non-covered services, and it raises several questions. If we are a preferred provider and a Delta Dental patient wants crowns or veneers on #8 and #9 strictly for cosmetic reasons, can we charge the patient our full fee? Or are we still limited to our Delta Dental contracted fee?

Many states now have laws regulating non-covered services. However, interpretation of these laws may vary depending on who you ask. We contacted the dental directors for two Delta Dental plans (Washington and Iowa), and their interpretation follows:

Services provided solely for cosmetic reasons are exclusions in our contracts. Contract exclusions are considered non-covered services–and therefore, the dentist can charge whatever fee he/she thinks is appropriate (independent of any Delta Dental contract fee). We would strongly encourage the dental provider’s staff to ensure there is a signed consent form that documents the fact that the procedures are being done for cosmetic/esthetic reasons.

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