The new policy includes the following provisions:
- Instead of monthly payments, Delta CO will pay the benefit out in two payments over the treatment plan with one payment at banding for 50% of the plan's ortho max (or the submitted fee, if it is less) and a second 50% payment one year later (if the patient is still eligible at that time).
- The final payment will not pay more than the allowed amount of the treatment plan.
- The final payment will also be reduced by any ortho payments previously issued.
- Any ortho cases of 12 months or less will be paid out in one payment.
This policy change went into effect for risk groups on 11/1/2017. For self-funded (ASC) groups, this went into effect on 2/1/2018. If you have any questions regarding this new payment policy, please contact your Delta Dental CO provider advocate.