After your trip to the dentist, you might be wondering what comes next. Will you need to pay in-office? How can you interpret the documents you may receive? Here's what you need to know after you visit the dentist.
You may have a copay or coinsurance that you need to pay in the dentist's office during your visit, depending on your plan type. If you owe anything for your visit, you may be asked to pay a portion or all in the office or receive a bill — this will depend on your dental office's billing practices. Log in to your account for more information.
After a visit to the dentist, you will receive a document in the mail called a dental benefits summary. You may also see this called an explanation of benefits (EOB). What is it and how can you read it?
A dental benefits summary or EOB is not a bill. Instead, it’s a document that breaks down the care you’ve already received, what portion is covered by your plan and what portion you may owe to your dentist. Watch this video for a detailed look at the different parts of this document. Log in to your account to access your documents.
You may notice a difference on your dental benefits summary between the submitted fee and the accepted fee. 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 dental service. Log in to your account to access your documents.
If you have elected to receive claim statements and other plan documents by mail, you should receive them in the mail after your visit to the dentist if there is a balance due. However, you can also access your claim statements and other documents at any time by logging in to your online account. Your claim statements can be viewed and downloaded as PDFs by navigating to the Plan documents section.
A claim statement will show information related to your dental plan usage, including the date and type of service you received, how much it cost, and your portion of the bill plus what Delta Dental pays.
Delta Dental dentists will handle all claims and paperwork for you, but if you visit a non-Delta Dental dentist, you may need to file the claim yourself. Claims are typically processed within two weeks unless additional information is required from you or your dentist. Note that if you receive treatment outside the U.S., non-English documents may be accompanied by a translation.
Here’s how to file a claim:
Note: If any of the information above is missing from the document you receive from your dentist, enter it onto the claim form.
Not satisfied with the service your dentist provided? We urge you to communicate directly with your dentist to address your questions and concerns. You can also contact customer service for assistance. If your concerns still haven’t been resolved, you may file a formal grievance.
How to file a formal grievance:
If you are submitting a grievance on behalf of someone other than yourself or a dependent age 18 or older, Federal HIPAA regulations require a signed authorization from that dependent to release any personal health information.
If you need assistance, you can contact customer service to file your grievance over the phone.
If you're outside of the country and you have a dental emergency, seek treatment immediately. You can visit any licensed dentist for emergency dental services.
You should pay the dentist for the services you receive at your appointment. Ask the dentist for a detailed receipt or billing statement for the services rendered. It should contain the following:
If possible, have the receipt or billing statement translated into English to facilitate claim processing in a timely matter.
Submit your claim following the "File a claim" FAQ.