Delta Dental is committed to protecting patient rights. We believe that you, as a Delta Dental 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
Delta Dental maintains some of the largest PPO and HMO dentist networks in the industry — each with a full range of specialists — to give you the widest possible choice of dentists.
Our fee-for-service plans allow you to visit any dentist at any time, without prior notification or authorization from Delta Dental. Our dental HMO plans do require you to choose a network dentist, but allow you to change dentists with an easy toll-free call; coverage for emergency or urgent care is part of our DeltaCare® USA plans.
The Right to Quality Assessment
We have programs to monitor the quality of care provided by dentists who participate in our networks. Each dentist who contracts with Delta Dental agrees to provide care that meets the high standards of the dental profession. Dentists participating in our prepaid network undergo even more checks of their credentials and office procedures. Our dentist contracts allow Delta Dental to inspect dental charts and to audit dental offices in person -- at random and for cause — to help ensure that they meet these standards. If you think you have received substandard care, Delta Dental will fully investigate the matter and can arrange for you to be reimbursed and/or retreated where appropriate.
The Right to Affordability
Delta Dental works with dentists to establish fair and reasonable compensation. Delta Dental contracts prohibit dentists from billing you for charges in excess of the amounts determined by us, and for services that should be included with certain procedures, or for any amount that is Delta Dental's responsibility.
We design Delta Dental benefit plans to promote preventive care, avoiding dental disease before more costly treatment becomes necessary.
To maximize the portion of your benefit dollars that are spent directly on the delivery of appropriate dental care, Delta Dental spends on average 90 cents of every premium dollar for such care. The remaining ten cents is directed to administrative activities such as claims processing and quality review.
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 Delta Dental compensates your dentist. Delta Dental provides materials to explain these features to you.
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.
To request a copy of your Evidence of Coverage, please contact us.
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. We do the review internally, but it may be referred to outside parties if warranted.
To submit a grievance to Delta Dental, use one of our secure forms.
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 plans — information isn't sold or used for third-party marketing efforts.
The Right to Security
You are entitled to a dental plan backed by a financially stable institution. Delta Dental's current reserve (several months of claims payments) helps to ensure the corporation can meet its expected financial obligations, as well as to withstand unforeseen business developments without risk to you, your dentist or employer.
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 by practicing personal dental hygiene and receiving regular professional care. 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 copayment or coinsurance amounts or deductibles required by the plan). It means cooperation with Delta Dental policies designed to protect against healthcare fraud schemes by other enrollees or dentists. It also means taking advantage of the information available on dental health and your dental plan so that you can become a more informed consumer.