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Long before
the current political debate over managed care, Delta
Dental established a commitment 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 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. You can visit any dentist
at any time, without prior notification or authorization
from Delta Dental.
While we support
the right of patients to choose their dentist, we
recognize our responsibility to provide some assurances
of quality care.
Therefore,
each of the thousands of dentists who have contracted
with Delta Dental agree to provide care that meets
the high 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, Delta Dental will fully
investigate the matter and can arrange for you to
be reimbursed and/or retreated as needed.
Delta Dental
contracts with dentists provide fair and reasonable
compensation. Those contracts also prohibit dentists
from billing you for excess charges, for “add-on”
procedures that should already be included or for
any amount that is Delta Dental’s responsibility.
Delta Dental's
benefit plans are designed to promote preventive care,
avoiding dental disease before more costly treatment
becomes necessary.
Because you
are entitled to have a maximum portion of your benefit
dollars spent directly on the delivery of appropriate
dental care, Delta Dental spends an average 90 cents
of every premium dollar for such care. The remaining
10 cents is directed to administrative activities
such as claims processing and quality review.
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.
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
review is done internally, but may be escalated to
outside parties if warranted.
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.
You are entitled
to a dental plan backed by a financially stable institution.
Delta Dental and its affiliates' current $300 million
reserve helps to ensure the corporation can meet its
expected financial obligations, as well as to withstand
unforeseen business developments without risk to you
or your dentist.
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/coinsurance
or deductibles required by the plan). It means cooperation
with Delta Dental's policies designed to protect against
healthcare fraud schemes by fellow 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.
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