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 subscriber, 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. You can visit any dentist at any time, without prior notification or authorization from Delta Dental.

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 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.

The Right to Affordability

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 85 cents of every premium dollar for such care. The remaining 15 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 (“predetermination”), 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.

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 review is done internally, but may be escalated to outside parties if warranted.

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 Right to Security

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.

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/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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© 2007 Delta Dental Insurance Company

The AARP Dental Insurance Plan is administered by Delta Dental Insurance Company. The plan is insured by Delta Dental Insurance Company in AK, AL, DC, DE, FL, GA, LA, MD, MS, MT, NV, NY, PA, PR, TN, TX, UT, VI and WV (Policy DDIC1230), by Dentegra Insurance Company in AR, AZ, CA, CO, CT, HI, IA, ID, IL, IN, KS, KY, ME, MI, MN, MO, NC, ND, NE, NJ, NM, OH, OK, OR, RI, SC, SD, VA, WA, WI and WY (Policy DIC1230), and by Dentegra Insurance Company of New England in MA, NH and VT (Policy DICNE1230). Policy numbers may vary by state. AARP endorses the AARP Dental Insurance Plan. Delta Dental Insurance Company pays a fee to AARP and its affiliate for use of the AARP trademark and other services. Amounts paid are for general purposes of AARP and its members. AARP does not make dental plan recommendations for individuals. You are strongly encouraged to evaluate your needs before choosing a dental plan.