|
|
 |
|
| HOW TO USE THE PROGRAM / CHOICE OF CONTRACT DENTIST |
|
| |
| To enroll in this Program, you must select a Contract Dentist from the list of dental facilities furnished with this Contract. You must indicate the Contract Dentist's name and facility ID # on the Enrollment and Payment Authorization Form. YOU AND YOUR ELIGIBLE DEPENDENTS MAY OBTAIN TREATMENT FROM ANY CONTRACT DENTIST AT THE SAME FACILITY.
Shortly after enrollment, you will receive a DeltaCare USA membership packet that tells you the Effective Date of your coverage. The packet will also show the address and telephone number of your Contract Dentist. You may obtain covered dental services any time after your Effective Date. To make an appointment simply call your Contract Dentist's facility and identify yourself as a DeltaCare USA Enrollee. Initial appointments should be scheduled within four weeks unless a specific time has been requested. Inquiries regarding availability of appointments and accessibility of Contract Dentists should be directed
to the Customer Service department at (800) 422-4234.
YOU AND YOUR ELIGIBLE DEPENDENTS MUST GO TO YOUR ASSIGNED CONTRACT DENTIST TO OBTAIN BENEFITS, EXCEPT FOR EMERGENCY SERVICES OR SPECIALIST SERVICES PREAUTHORIZED BY US AS DESCRIBED BELOW. ANY OTHER TREATMENT IS NOT COVERED UNDER THIS PROGRAM.
|
| |
|
|
|
HIPAA Notice of Privacy Practices | Web Site Privacy Notice
© 2008 Delta Dental |
|
