Delta Dental member resources after your visit

Depending on your plan and your dental office's billing practices, you may need to pay a copayment or coinsurance during your visit. If you go to an out-of-network dentist, you'll likely pay up front and submit a claim to request reimbursement. For more details, see the File a claim section on this page.

After a visit to the dentist, you'll receive a dental benefits summary or Explanation of Benefits (EOB), which lists the procedures done, the portion of the fee that's covered by your plan and what you may owe to the dentist. For more details, watch Your Explanation of Benefits, Explained (video, 1:44 minutes).

If you have opted to go paperless, you'll receive an email notification when an Explanation of Benefits or other plan document is available. To view the document, log in to your account. Otherwise, you'll receive your documents by mail. 

To view your Explanation of Benefits, log in to your account. 

The submitted fee is the amount that the dental office charges for your service and submits to Delta Dental. The accepted fee is the amount your dentist agrees to accept from Delta Dental as full payment for your service. 

If you visit a non–Delta Dental dentist and pay upfront, you may need to submit a claim. To do this, log in to your account and select Claims & visits and then "how to file a claim."

You can also download the claim form for your plan here:

 Delta Dental PPO™ claim form
 DeltaCare USA® claim form

Be sure the dentist signs the form and provides a statement of treatment or a detailed receipt that includes:
 

• Dentist’s name, address and phone number
• Date each service was performed
• Description, procedure code and fee for each service performed
• List of affected teeth
• Total cost of services performed
• Dentist’s National Provider Identifier (NPI)
• Dentist’s Tax Identification Number (TIN)
• State license number
• Specialty code
   

If any of the information above is missing from the document you receive from your dentist, enter it on the claim form.

Complete, print and sign the form. Be sure the dentist signs it as well. Keep copies of the form and documents, and mail the originals to the address at the top of the claim form.

If you're out of the country and you have a dental emergency, seek treatment from a licensed dentist immediately. Your plan may cover emergency dental services up to a certain amount. 

Follow the How to file a claim instructions in the previous section. If possible, have any receipt or billing statement that's in another language translated into English so your claim can be processed in a timely matter. If the dentist's fee was paid in a different currency, it will be converted into U.S. dollars when the claim is processed.

If you're not satisfied with the service your dentist provided, contact the dental office. If your concerns still aren't resolved, you may file a formal grievance.
 

• Delta Dental online grievance form
•  CA DMHC cancellation of health care coverage grievance form (PDF, 32.5 KB)
   

If you are submitting a grievance on behalf of a dependent age 18 or older, you'll need the dependent to submit a signed  authorization form (PDF, 168 KB) to release their personal health information, per federal HIPAA regulations.  

If you need assistance, contact us to file your grievance over the phone.

For DeltaVision® members: If you’re not satisfied with the care, treatment, or services you received from your eye care provider, please visit this page and notify our partner VSP® Vision Care.