Word of Mouth

Using radiographic imaging and detailed treatment descriptions, our dentists determine whether coverage for treatment is approved or in certain cases, denied. In other words, our dentists ensure that benefits are used and applied fairly.

Dr. Joseph Borg, our Director of Dental Policy says, “Our processing policies, backed by our staff of dental consultants, are beneficial to our clients and their employees because they ensure oversight of their benefits dollars — we’re making sure that services are administered and processed appropriately.”

Our dental consultants personally evaluate more than 200 claims per day, ensuring that:

• Treatment and billing for pre-defined services (e.g., crowns, bridges and periodontal surgery) are appropriate and meet Delta Dental’s stated clinical guidelines.
• Exceptions to frequencies and/or age limitations are made where appropriate or necessary.
• Treatment is billed appropriately; for example, a complex service isn’t “unbundled” into a variety of separate codes.

Dr. Thomas Gale, a dental consultant in our Alpharetta, Georgia office notes, “We want enrollees to get the most from their benefits — the care they expect, the care they require and the care they’re charged for.”

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