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Delta Dental or the Administrator shall provide notification if any dental services or claims are denied, in whole or in part, stating the specific reason or reasons for the denial. If you have any complaint regarding eligibility, the denial of dental services or claims, the policies, procedures or operations of Delta Dental or the Administrator or the quality of dental services performed by a Contract Dentist or Contract Specialist, you may call the Customer Service department at (800) 422 4234, or the complaint may be addressed in writing to:
Delta Dental Insurance Company
Quality Management Department
12898 Towne Center Drive
Cerritos, California 90703-8579
Written communication must include:
- the name of the patient,
- the name, address, telephone number and identification number of the primary Enrollee and
- the Dentist's name and facility location.
Within 10 business days of the receipt of any complaint, the quality management coordinator will send you an acknowledgment of receipt of the complaint. Certain complaints may require that the complainant be referred to a Dentist for a clinical evaluation of the dental services provided. Delta Dental will make a determination, in writing, within 30 days of receipt of a complaint or shall provide a written explanation if additional time is required to report on the complaint. A review of the decision shall be undertaken if a written request for an appeal of the determination is made within 30 days of the date of the written determination. Delta Dental shall undertake a full and fair review upon request. Delta Dental may require additional documents, as it deems necessary in making such a review. Delta Dental shall provide a written response to the complainant within 30 days after receipt of the appeal and supporting documentation or a written explanation if additional time is required to issue the results. |
