|
|
 |
|
| 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 MAY OBTAIN TREATMENT FROM ANY CONTRACT DENTIST AT THAT FACILITY.
Shortly after enrollment, you will receive a membership packet which advises you of 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 an Enrollee in this Program. Your assigned Contract Dentist also maintains a 24-hour Emergency Dental Services system seven days a week. Initial appointments should be scheduled within three 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.
EACH ENROLLEE MUST GO TO THEIR ASSIGNED CONTRACT DENTIST TO OBTAIN BENEFITS EXCEPT FOR SERVICES PROVIDED BY A CONTRACT SPECIALTY CARE DENTIST OR FOR EMERGENCY DENTAL SERVICES. (REFER TO SCHEDULE A.) ANY OTHER TREATMENT PROVIDED BY AN OUT-OF-NETWORK DENTIST (UNLESS EXPRESSLY AUTHORIZED BY ALPHA) IS NOT COVERED UNDER THIS PROGRAM. |
| |
| |
| |
| |
HIPAA Notice of Privacy Practices | Web Site Privacy Notice
© 2008 Delta Dental |
|
