What dentists can I see with my Direct Dental Plan?
You may see any dentist that you wish with your Direct Dental Plan.
If your employer has access to the Dental Health Alliance (DHA) network, then you have access to see dentists in this network at a discounted rate. Please review your plan’s Benefit Summary, or consult with your HR department to determine if you have access to the DHA network. Choosing to see a dentist in the network will stretch your benefit dollars and reduce your out-of-pocket expenses.
Please be advised that if you use an out-of-network provider, they have not agreed to provide services to your Plan at a reduced rate and your out-of-pocket expenses may be higher. They may require full payment at the time of service, they may balance bill you, and they may require you to file your own claims with Direct Dental.
What do I need to bring to my dentist to use the plan?
You no longer need to present a physical identification card when you go to the dentist. Your provider can verify your eligibility in one of four simple ways:
Your provider can contact Provider Services at 855-866-2615 to verify your eligibility.
Your provider can look up your eligibility on the Direct Dental Provider Web Portal.
If you would like an identification card, just print out a card by going to the Member Web Portal. Direct Dental members have the convenience of a digital member identification card. You can even provide your digital member identification card on your smart phone or mobile device when you’re on the go. You must register with the portal as a member to view or print your ID card.
You may also bring a copy of your Plan Benefit Summary to your provider. Your Plan Benefit Summary is available to you in the Member Web Portal or from your HR team.
How do I register with the Member Web Portal?
How does my provider submit my claim and get paid?
Your provider can send your claim to Direct Dental electronically via our Provider Web Portal, via other electronic claim services including Emdeon and DentalXChange, or via fax/mail. Click here to see Direct Dental’s claim submission information for Providers.
What if I pay my provider out of pocket for services?
If you pay out of pocket for services, you can send us a Claim Reimbursement Form along with clean copy of your claim receipt(s).
When will I receive payment if I paid out-of-pocket for services?
You can expect to receive your reimbursement within 30 days or less of Direct Dental receiving your Claim Reimbursement Form along with clean copy of your claim receipt(s). Please note that failure to provide appropriate documentation with your reimbursement request may result in delays in the processing of your claim.
What is an Explanation of Benefits or EOB?
An Explanation of Benefits (EOB) is a document you receive from Direct Dental after you visit the dentist. It is not a bill, but rather an explanation of what procedures were performed and what was covered by your dental plan. Your EOB will show It will also include an update on how much of your annual maximum has been used and the amount you’ve paid toward your deductible.
Where can I get my Explanation of Benefits or EOB?
You can download your Explanation of Benefits (EOB) from the Member Web Portal under the Documents tab in the top navigation panel as soon as your claim has been processed.
What is a deductible?
A specific dollar amount that you must pay before your dental plan begins to cover your expenses. Some Direct Dental plans will require you to pay a deductible. Please consult your Plan Benefit Summary Your Plan Benefit Summary is available to you in the Member Web Portal or from your HR team.
What are UCR Fees and how do they work?
Your plan may limit the allowable amount for services will be based upon the Usual, Customary and Reasonable (UCR) Fee Schedule for the treating dental office zip code. For example:
A 90% UCR Fee Schedule means the plan will allow the fees that 9 out of 10 dentists charge for services within the treating dental office zip code.
Any difference between the billed amount for a given service and the 90% UCR allowed amount for the treating dental office zip code is the patient’s responsibility.
You can contact Member Services at 855-844-0626 and they will provide the allowable UCR amount for a given service within the treating dental office’s zip code.
Are all dental services covered by my Direct Dental Plan?
Your Plan Benefit Summary describes the services covered by your plan, as well as limitations and exclusions. Your Plan Benefit Summary is available to you in the Member Web Portal or from your HR team.
Does my Direct Dental Plan cover braces or orthodontic care?
Your Plan Benefit Summary describes the services covered by your plan. Your Plan Benefit Summary is available to you in the Member Web Portal or from your HR team. For more information on how Direct Dental pays orthodontic benefits please click here.
How do I coordinate benefits with another dental plan?
If you are the primary subscriber and you receive care, Direct Dental is the primary carrier, and secondary benefits are handled by your secondary carrier.
If a dependent with their own primary coverage receives care, we use the Explanation of Benefits (EOB) from the dependent’s primary carrier and pay benefits against what remains from the primary carrier.
Please contact Member Services at 855-844-0626 to provide additional coverage information.
What is a pre-claim estimate for benefits?
For more extensive treatments, a dentist can request a cost estimate from Direct Dental. This pre-claim estimate will let you know in advance what procedures are covered and how much you will have to pay towards the treatment.
What is my remaining available balance?
The amount of your remaining available balance, as well as your claim status and history, can be found in the Member Web Portal under the Benefit tab in the top navigation panel.
You may also contact Member Services at 855-844-0626 for assistance with your balance and more.