Good oral health care plays a large role in helping to keep small dental problems from turning into bigger health issues down the road. To ensure that you get the absolute best value from your dental plan, we've gathered some important information about how your plan works.
Our participating dentists encourage preventive care and handle all the claims, paperwork and inquiries directly with us. There is no balance billing. At non-participating dentists, you pay first, then submit a claim, and then you'll be reimbursed up to our allowance, minus any co-insurance or deductible.
At the participating dentist's office, show your identification card and discuss your treatment. After your visit, the dentist's office will file the claim and we will pay the dentist for covered services.
If your dentist relocates or decides not to participate with Delta Dental, you can choose a new participating provider from our network without any disruption in your coverage or benefits.
You always have the option of going to a non-participating dentist; however, it will likely cost you more money.
You are expected to pay the difference between the non-participating dentist's full charge and Delta Dental's payment.
You may also have to file the claim and be reimbursed by us directly. Ask the dentist to complete a standard American Dental Association claim form. You should pay the dentist his or her charges. It is your responsibility to mail the form to
Delta Dental of Rhode Island, PO Box 1517, Providence, RI 02901-1517.
Whenever your dentist recommends treatment that is expected to cost $300 or more, we suggest that the dentist file a pre-treatment estimate with Delta Dental. We will review the treatment plan and let you and the participating dentist know, in advance, how much we will cover. For services that your dental plan does not cover at 100%, a pre-treatment estimate lets you know what your out-of-pocket cost will be.
You are covered for procedures rendered in a dental office by a licensed dentist, provided these procedures are covered benefits under your plan. Delta Dental only covers services received in a dental office; we do not cover services rendered in a hospital, surgi-center or urgent care facility.
In the event of a life-threatening emergency, you should go to the nearest hospital for treatment and submit any claims to your medical insurance plan. Similarly, if you have an urgent dental condition, you should seek treatment at the nearest dentist's office, regardless of whether the dentist participates with Delta Dental. You do not need prior approval before seeking treatment; however, your dental plan will only pay for covered benefits at Delta Dental-approved rates.Most dental offices treat patients within 24 hours for an urgent appointment. If you need help selecting a participating dentist, call customer service for a list of dentists in your area or use our Find A Dentist tool.
Delta Dental also provides toll-free customer service with InfoLine - our automated telephone information system. Call 1-800-84DELTA (800-843-3582) 24 hours a day, 7 days a week. Our Customer Service Representatives are also available Monday through Friday, 8 a.m. to 5 p.m. (ET) to answer questions or resolve problems.
Our convenient Members Online feature provides you with round-the-clock access to the latest information about your personal benefits.