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FAQ: Claims
and coverage
Find answers to the questions
below.
Where
do I send my claims ?
You can submit your claims to the
following:
Delta Dental Insurance Company
P.O. Box 1809
Alpharetta, GA 30023-1809
You
can download our claim form here.
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How can
I get a claim reevaluated?
If you do not agree with Delta's determination
of benefits, and you have additional information to
supply, you may request reevaluation by resubmitting
with the reason for reevaluation, a copy of the Notice
of Predetermination or the claim detail section of
the Delta payment check, x-rays or photos and clinical
comments to:
Professional Services
P.O. Box 1809
Alpharetta, GA 30023-1809
Delta allows one reevaluation per
claim.
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Why does
Delta require submission of x-rays for some procedures?
Delta requires x-rays on certain
procedures to help us determine if treatment is covered
under the patient's program. For example, consultants
will review a preoperative radiograph when a claim
is received for a cast restoration to see if the contractual
criterion has been met for coverage: that so much
tooth structure has been lost from caries or fracture
that a direct amalgam or resin restoration would not
be an adequate restoration.
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Why
doesn't Delta cover some procedures, such as implants?
Delta offers coverage for procedures
such as implants and additional cleanings that any
group can elect to include in its contract at additional
cost. Other coverage available from Delta includes
cosmetic dentistry and enhanced periodontal benefits.
Most clients try to spend their available benefit
dollars to provide the greatest benefit to the largest
number of employees. Lack of coverage for a particular
service does not imply that the service is not necessary
or beneficial.
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