At Midtown Dental, our priority has always been providing high-quality, personalized care, without rushing treatment or compromising on our patient experience. Over time, Delta Dental’s reimbursement structure has made it increasingly difficult for us to continue delivering the level of care and attention our patients expect and deserve.
Starting October 1, 2026, our practice will transition to out-of-network with Delta Dental. This change does not mean you'll lose your benefits – in fact, most patients are pleasantly surprised to find that their benefits can still be used and their visits remain much the same.
Our team at Midtown Dental is here to guide you every step of the way.
What “Out-of-Network” Really Means: In-Network vs. Out-of-Network Explained Simply
Being out-of-network does not mean:
- You can’t use your dental insurance
- You have to find a new dentist
- You lose your benefits
It simply means Delta Dental’s set fees no longer contractually limit our practice.
Here's what will stay the same:
- You can still receive care with us
- Your insurance can still reimburse you
- We submit claims on your behalf
- Our team helps you understand your benefits before treatment
Instead, Delta Dental reimburses based on its out-of-network allowance rather than a contracted fee. Patients may receive reimbursement directly, depending on their plan.
Examples of Out-of-Network Reimbursements
Here are a few examples of what this can look like in real life. Please note that these examples are for educational purposes only; actual coverage and reimbursement amounts vary by plan.
Example 1: Preventive Care (Routine Exam & Cleaning)
- Midtown Dental Fee: $150
- Delta Dental Out-of-Network Allowance: $120
- Insurance Reimbursement: $96 (80%)
- Estimated Patient Portion: $54
Many preventive services still receive strong coverage even when out-of-network, making routine visits very manageable for most patients.
Example 2: Basic Restorative Care (Dental Filling)
- Midtown Dental Raleigh Fee: $280
- Delta Dental Out-of-Network Allowance: $200
- Insurance Reimbursement: $160 (80%)
- Estimated Patient Portion: $120
Out-of-network care often allows your dentist to use higher-quality materials and techniques without insurance-driven restrictions.
Example 3: Major Treatment (Dental Crown)
- Midtown Dental Raleigh Fee: $1,400
- Delta Dental Out-of-Network Allowance: $1,000
- Insurance Reimbursement: $500 (50%)
- Estimated Patient Portion: $900
While insurance may cover a smaller percentage for major services, many patients prefer out-of-network care for its focus on longevity, precision, and comfort.
Example 4: Insurance Maximum Consideration
- Annual Insurance Maximum: $1,500
- Amount Insurance Has Already Paid This Year: $1,000
- Remaining Available Benefit: $500
Out-of-network reimbursement still applies toward your annual maximum, just like in-network care.
What These Examples Show
- You can still use your Delta Dental benefits
- Insurance often continues to cover a portion of care
- Out-of-network fees reflect the true cost of quality dentistry
Our team helps you plan ahead and understand your expected costs before treatment begins. Before any treatment:
- We review your insurance benefits
- Provide clear cost estimates
- Explain expected reimbursement
- Discuss payment and financing options if needed
Our goal is to ensure you have no surprises when it comes to the costs of your care, just clarity and confidence.
How Midtown Dental Raleigh Handles OON Benefits
We're here to make it easy to navigate your insurance policy and benefits with:
- Complimentary insurance benefit checks
- Transparent cost estimates before treatment
- Claims submitted on your behalf
- Support with reimbursement questions
- Flexible payment and financing options
Our Raleigh dental team is trained to help you maximize your benefits, even when we’re out-of-network.
Have Questions? We’re Here to Help.
If you have questions about your Delta Dental coverage or how this change may affect you, contact our office today. We’re committed to making this transition smooth, transparent, and stress-free.
