Dentist Office Questions
Claims Questions, cont...
Answers to Dentist Office Questions
Q: I haven’t received my ID card yet, but I have an appointment scheduled. What information does my provider need? How can I obtain an ID card?
A: Your dental office will need your social security number or member identification number. The dentist’s office may also call our office to verify coverage. You may call our office at 1-800-735-3379 to request a new ID card.
Q: May I visit any dentist I wish for treatment? What if my dentist doesn’t participate with Delta Dental?
A: Unless you are covered by Kid Care CHIP, you are free to visit any dentist. However, you may have more out-of-pocket expense and will be responsible for the difference between Delta Dental’s payment and the dentist’s fee, along with your co-insurance if the dentist is not a Delta Dental participating dentist. In addition, depending on your employer-selected benefit plan, your coverage may involve a larger deductible and/or different co-insurance percentage if you go to a dentist who doesn’t participate with your specific plan. Locate a participating dentist here or contact us at 307-632-3313 or toll free at 1-800-735-3379.
Q: How do you handle claims submitted by a non-participating dentist?
A: Please note that if you visit a non-participating dentist, you may be required to submit a claim form for the services rendered and possibly pay the entire amount up front. In all instances, when a non-participating dentist renders services, any payment made by Delta Dental will be made directly to you, the subscriber.
Answers to Claims Questions
Q: What is Delta Dental of Wyoming's mailing address?
A: P.O. Box 29, 320 West 25th Street, Cheyenne, WY 82001.
Q: I just received something in the mail from Delta Dental that looks like a bill. What is it?
A: You probably received an Explanation of Benefits (EOB) statement. This statement is not a bill; it explains what services your dentist provided and how Delta Dental processed and paid for the services.
Q: What are predeterminations and are they mandatory?
A: A predetermination of benefits allows you to know in advance what procedures are covered, the amount your plan will pay toward treatment and your financial responsibility. Some groups and some conditions require a predetermination of benefits before treatment is performed. Treatment plans that involve prosthodontic services, orthodontic services, individual crowns (except stainless steel), gold restorations, surgical periodontics, endodontics and oral surgery, except for simple extraction of a single tooth, should be submitted to Delta Dental for predetermination of benefits. Please refer to your Benefits Booklet to see the exact services for which predeterminations are required. Even if it is not required, Delta Dental encourages predeterminations for extensive treatments, or if you visit a non-participating dentist. There is no charge for a predetermination and it is valid for ninety (90) days.
Q: Does my group coverage run on a calendar year or a contract year?
A: The anniversary date for coverage varies from group to group. For specific information on your benefits or benefit year, you can check your Benefits Booklet or contact us at 307-632-3313 or toll free at 1-800-735-3379.
Q: Does Delta Dental of Wyoming offer individual policies?
A: No, not currently.
Q: When am I eligible for dental coverage? Does Delta Dental have waiting periods for services?
A: Some employer groups have various waiting periods. Please check your Benefits Booklet to see if your group imposes waiting periods or log-on to the Subscriber Connection.
Q: I’m covered under two dental plans. How is my coverage handled?
A: If you and your family are covered by both Delta Dental of Wyoming and another Delta Dental Member Company, another dental carrier or medical plan that offers dental coverage, Delta Dental coordinates benefits with the other carrier. Generally, if you are covered as an employee and also as a dependent of an employee at another company, the coverage through your employer is primary. Children covered by parents who work for different employers are usually primary under the plan of the parent whose birthday occurs first in a calendar year (not necessarily the oldest parent). In determining coverage, total payments from both carriers cannot exceed 100 percent of the approved fee for the service. Please note that some groups have specified a “carve-out” clause in their dental programs that might limit a secondary carrier’s payment. If you have a question about Coordination of Benefits, please contact us at 307-632-3313 or toll free at 1-800-735-3379.
Q: Do I need a referral to see a specialist?
A: If you’re a member of Delta Dental, you do not need a referral to receive care from a specialist. However, we strongly encourage you to use the services of a Delta Dental participating specialist to maximize your benefit coverage.
Q: How do I check to see if I am eligible for coverage?
A: It’s easy to check your current eligibility status and view a summary of your plan’s dental benefits online using the Subscriber Connection or contact us at 307-632-3313 or toll free at 1-800-735-3379.
Q: Can I add a family member to my dental coverage at any time?
A: No. Dependent family members can only be added at the renewal date of the group contract if the employer allows open enrollment periods or when a qualifying event occurs.
Q: What does Delta Dental consider a qualifying event?
A: The following are considered qualifying events:
- Birth/legal custody/adoption
- Loss of other dental insurance coverage
Q: Can I elect coverage during a contract year?
A: Coverage can be elected at your employer's renewal date if your employer allows an open enrollment period or if a qualifying event occurs.
Q: When does coverage begin after a qualifying event occurs?
A: Coverage begins the first of the month following the date of the qualifying event. Delta Dental must receive notice of the change in eligibility status within 31 days of the qualifying event otherwise the change may only be made at the renewal date of the group contract if the employer allows such open enrollment.
Q: How do I get an explanation of my dental coverage?
A: A Benefits Booklet explaining coverage is usually available through your employers Human Resources Department. You can also view your dental benefits summary within the Subscriber Connection.
Answers to Claims Questions
Q: I had a tooth surgically pulled (extracted) and the dental claim was filed with my medical insurance. Why doesn’t my dental plan cover the claim?
A: Depending on your group coverage, claims for surgical extraction of wisdom teeth may need to first be submitted to your medical insurance carrier and then to your dental plan. Some medical plans pay up to 100 percent of this procedure, so filing this type of extraction with your medical insurance could be of benefit to you. If there are any remaining charges after the medical insurance carrier has paid, your dental plan may cover the remainder or a portion of the remaining balance. Contact us at 307-632-3313 or toll free at 1-800-735-3379 for specific details regarding your plan.
Q: Why does Delta Dental reimburse orthodontic payments monthly instead of paying the entire amount up front?
A: Orthodontic payments are distributed throughout the period of time the services are rendered. This eliminates problems and confusion if the treatment is completed early, if the member’s coverage is terminated, if the group terminates, or if the dependent reaches the age limit for orthodontic benefits or for dependent coverage. Delta Dental’s policy is to pay only for completed services, so once the monthly visit is completed, a payment will follow.
Q: Why did Delta Dental pay for a silver (amalgam) filling in my back tooth when my dentist filled the tooth with a white (composite) filling?
A: Your plan only covers the cost of an amalgam filling in a posterior (back) tooth. If you and your dentist decide to restore the tooth with a composite resin, Delta Dental will allow for the cost of the amalgam, and you will be responsible for the remaining cost.
Q: Why was my exam not covered when my dentist referred me to a specialist?
A: According to your group contract, examinations are covered benefits that may be subject to frequency limitations. This is true whether the examination is performed by a general dentist or by a specialist.
Answers to Dependent Questions
Q: My child has braces and we just switched to Delta Dental. Are our orthodontic payments covered under our Delta Dental insurance?
A: Depending on your group contract regarding orthodontic takeover coverage, Delta Dental may or may not assume coverage of orthodontic benefits. To determine if your plan includes coverage for orthodontic services that are in-progress, check your Benefits Booklet or contact us at 307-632-3313 or toll free at 1-800-735-3379.
Q: Why was my son/daughter taken off my dental policy?
A: Check with your group administrator to determine what your dependent policy is.
Q: What do I need to send to Delta Dental to verify my child's full-time student status?
A: Please provide Delta Dental with a completed copy of the Dependent Status Form that proves the student is enrolled at a secondary institution and is taking at least 12 credit hours. This form is available on our website. Acceptable documentation includes a copy of a paid tuition bill or a letter from the registrar.
Q: I have a fully disabled dependent; how long is he/she covered under my policy?
A: As long as the individual remains disabled and is fully dependent on you for support and unmarried, he or she can remain a dependent on your insurance policy. Written proof is required from the attending physician to verify the dependent's disability.
Q: Can I add family members to my dental coverage at any time?
A: Dependent family members can only be added during open enrollment periods through your employer or when a qualifying event occurs.
Answers to COBRA Questions
Q: How do I apply for COBRA coverage?
A: You should contact your former employer regarding eligibility for COBRA coverage and to request an application for continuation of group dental coverage.
Q: Are all employers required to offer COBRA coverage?
A: Not all employers are obligated to offer COBRA coverage. Please check with your former employer for information on COBRA coverage. COBRA enrollment periods may vary, so please ask about enrollment deadlines and length of coverage as well.
Q: When does my COBRA coverage start?
A: Normally, COBRA coverage begins the day following your last day of coverage under the active employee plan. However, please check with your former employer for specific information regarding your individual situation.
Q: I have not received a bill for my COBRA coverage. What do I do?
A: COBRA billing authority varies by employer. Your COBRA premium may be collected by Delta Dental, your former employer or by a third-party administrator hired by your former employer. Contact your former employer to inquire about payment procedures for your group.
Federal law does not require us to provide a monthly billing statement. If Delta Dental is responsible for collecting your payment, we will send you a statement on a quarterly basis, but it is the responsibility of the COBRA participant to make sure that their payment reaches the billing authority by the due date stated. If payment is not received by the last day of the month for which premium is due, COBRA coverage will be terminated and can not be reinstated. For example, premium for October coverage is due on October 1. Coverage will terminate if payment is not received by October 31.
Q: How do I terminate my COBRA coverage?
A: If you wish to terminate your COBRA coverage, for which Delta Dental is the billing authority, please contact our COBRA representative at P.O. Box 29, Cheyenne, WY 82003 or at 1-800-735-3379. Please include your name, date of birth, ID number, the requested termination date and contact information. If your former employer or a third-party administrator is the billing authority for your COBRA coverage, please contact them directly.
If you have additional questions, please contact us at 307-632-3313, toll free at 1-800-735-3379 or via email at firstname.lastname@example.org.