Filing Claims

When you use network providers, you do not need to file a claim for benefits. Your network provider will file a claim on your behalf and Delta Dental will pay him or her directly. Keep in mind that you are responsible for paying the annual deductible if applicable to the network provider.

If you use non-network dentists, you may have to pay for the expense and then file your claim for reimbursement. Your claim should be submitted within 90 days after services are rendered, or as soon as reasonably possible—but no later than one year after the date of service. Claims submitted after that date may be denied or reduced, unless you are legally incapacitated.

When you submit a claim, be sure to include:

Your name, address, and member ID number
Patient's name and age
Name and address of the treating dentist
Diagnosis from the dentist that includes a complete dental chart showing extractions, fillings, or other dental services rendered before the charge for the claim was incurred
Radiographs, lab, or hospital reports
Casts, molds, or study models
An itemized bill which includes the CPT or ADA codes or description of each charge
The date the dental disease began
Statement indicating whether or not you are enrolled for coverage under any other health insurance plan or program (if you are enrolled for other coverage, you must include the name of the other carrier(s))

Send your completed claim form and dental bills to:

Delta Dental
P.O. Box 997330
Sacremento, CA 95899-7330

If you do not provide the above information—or any other information needed to confirm your eligibility for coverage—Delta Dental may delay or deny benefit payments.

If you want to have your provider paid directly, you may send a written request to Delta Dental authorizing direct payment. Whenever a law or court order requires payment of dental care expense benefits under the plan to be made to a person or facility other than you, the payment will be made to that person or facility.

Delta Dental will send you an explanation of benefits (EOB) for each claim you or your provider submit. The EOB will show you how much of the expense is the plan's responsibility and how much is yours. In addition, you can view your claims status and claim history online at Delta's website.

If your claim is denied, or partially denied, you have the right to appeal the decision. See Filing Claims under Legal Information for details about appealing your claim.