Informal Grievances
An Enrollee who has a grievance against Delta Dental for any matter arising out of this Contract may make an informal complaint by calling the toll-free number (800) 422-4234. A grievance is not considered formal until Delta Dental receives a written complaint.
Formal Grievances
Written complaints may be addressed to:
Quality Management Department
12898 Towne Center Drive, MS: QM600
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 a quality management coordinator will forward to the complainant an acknowledgement of receipt of the complaint. Certain requests may require that the complainant be referred to a Dentist in their area for 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. In no event will the decision on the request for review be sent more than 90 days after Delta Dental receives it.
Appeal of Decision
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 any 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 decision.
An Enrollee who is dissatisfied with the decision may appeal in writing to the State of Florida Office of Insurance Regulation.
The State of Florida Office of Insurance Regulation may be contacted at any time, concerning any complaint or request for assistance, by writing to 200 East Gaines St., Tallahassee, FL 32399, or by calling the Office’s toll-free consumer hotline: (800) 342-2762. |
