Patient Rights and Responsibilities

We believe that you, as an AARP® Dental Insurance Plan Enrollee, have the right to expect quality, affordable care that protects not only your dental health, but also your privacy and ability to make informed choices. We also believe that you have certain responsibilities to help protect these rights.

The Right to Choose

The Delta Dental system maintains some of the largest dentist networks in the industry*—each with a full range of specialists—to give you the widest possible choice of dentists. Dentists are never penalized for referring you to a specialist. For the Delta Dental PPO℠ option, you can visit any dentist at any time, without prior notification or authorization from Delta Dental. For the DeltaCare® USA option, your contract dentist must refer you to an approved specialist. If there isn’t a contract specialist in your area, we’ll provide a referral to an out-of-network specialist at no extra charge other than the applicable copayment.

The Right to Quality Assurance

While we support the right of patients to choose their dentist, we recognize our responsibility to provide some assurances of quality care.

Therefore, each dentist who has contracted with Delta Dental agrees to provide care that meets the standards of the dental profession. Dentist contracts allow Delta Dental to audit dental offices in person—at random and for cause—to help ensure that these standards are met. If you should ever receive substandard care from a Delta Dental dentist, Delta Dental will fully investigate the matter and can arrange for you to be reimbursed and/or retreated as needed.

The Right to Affordability

Delta Dental contracts with dentists to provide fair and reasonable compensation. Those contracts also prohibit dentists from billing you for excess charges, "add-on" procedures that should already be included, or for any amount that is Delta Dental's responsibility.

Delta Dental benefit plans are designed to promote preventive care, avoiding dental disease before more costly treatment becomes necessary.

The Right to Full Disclosure

You have the right to clear and complete information about your dental benefits, including treatment that is subject to limitations or not covered. You are entitled to know what your share of costs will be before you receive treatment ("pre-treatment estimate"), and how your dentist is compensated by Delta Dental. Delta Dental provides materials to explain these features to you.

Delta Dental dentists are not subject to policies sometimes called "gag clauses." You are entitled to hear about all treatment options your dentist may recommend, whether covered or not, and to obtain a second opinion if you choose.

The Right to Fair Review and Appeal

Delta Dental supports your right, as well as your dentist's, to a fair and prompt review of any of Delta Dental's coverage decisions. We maintain effective complaint resolution systems in the event of disagreement over coverage or concern about the quality of care.

The Right to Privacy

Delta Dental vigorously supports and protects the privacy of patient records and dental histories. Delta Dental also supports your right to gain access to all information pertaining to claims submitted on your behalf.

Data are used only for the purposes of designing and administering effective dental programs—information isn't sold, bartered or used for third-party marketing efforts.

The Responsibility to Protect These Rights

Protection of the rights described above is possible only with your cooperation. In order to ensure the continued enjoyment of these rights, you share:

The responsibility to participate in your own dental health—practicing personal dental hygiene and receiving regular professional care. You should avoid substances and behaviors that could jeopardize your oral health and cooperate with your dentist on his or her recommended treatment plans.

The responsibility to become familiar with your coverage. This includes meeting any financial obligation incurred as a result of treatment (including the appropriate copayments or deductibles required by the program). It means cooperation with Delta Dental policies designed to protect against health care fraud schemes by fellow Enrollees or dentists. It also means taking advantage of the information available on dental health and your dental program so that you can become a more informed consumer.

*Report by Ignition Group, 2010.

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