Members

Thank you for choosing Delta Dental Smiles for Kids!

As a Delta Dental Smiles for Kids member you have access to:

• Excellent dental benefits and customer service
  • Call us at (866) 864-2499, Monday - Friday, 7 am to 7 pm Central Time.
• A Primary Care Dentist (PCD) to visit regularly

Member Rights

As part of being with Delta Dental Smiles for Kids, you and your child have these rights:

1. Your child has the right to be treated with respect, dignity, and privacy.
2. Your child has the right to receive care no matter how they identify their race, color, nationality, disability, sex, religion, or age.
3. You have the right to get correct, easy-to-understand information to help you make healthy choices.
4. You have a right to file a complaint or grievance about us, a dentist, or the care you receive. This includes any abuse, neglect, or exploitation. For complaints, please call 1-800-482-8988, or refer to the contact information in Appendix A.
5. You have the right to file an appeal about an action or decision we make.
6. You have a right to know:
   • Why Delta Dental decides whether to cover or not cover a service.
   • Why Delta Dental decides if a service is medically necessary.
   • Who in Delta Dental’s office decides these things.
7. You have the right to know the names of Delta Dental Smiles for Kids Network dentists.
8. You have the right to pick from a list of dentists to get the right kind of care for your child.
9. You have the right to take part in all your child’s dental care decisions. This may include refusing treatment.
10. You have the right to get a second opinion, at no cost, from another Delta Dental Smiles for Kids Network dentist about what kind of treatment you need.
    • a. To request a second opinion please call us at 1-866-864-2499.
    • b. You must request your second opinion within 90 days of your original treatment plan.
11. 11.You have the right to fair treatment from us, Delta Dental Smiles for Kids Network dentists, and other dentists.
12. 12.You have the right to:
    • Talk to a dentist in private.
    • Have dental records kept private.
    • Request a copy of dental records.
    • Ask for changes to those records.
13. You have a right to know dentists who can inform you about your child’s:
    • a. Health status.
    • b. Dental care.
    • c. Treatment.
14. You have a right to know you are not responsible for paying for covered services. Delta Dental Smiles for Kids Network dentists can’t require you to pay for your child’s covered services.
15. You have the right to receive all information, including, but not limited to, informational materials, instructional materials, available treatment options, and alternatives in a manner and format that you can easily understand. Please contact us toll-free at 1-866-864-2499.
16. You have a right to get a spoken translation at no cost for all non-English languages, not just those identified as prevalent.
17. You have the right to recommend changes in policies and services under Delta Dental Smiles for Kids. Write us or call toll-free at 1-866-864-2499.
18. You have the right to receive detailed information on emergency and after-hours coverage. This includes, but is not limited to:
    • a. What counts as an emergency medical condition, emergency services, and services after you are stabilized.
    • b. Emergency services don’t require prior approval.
    • c. The process and procedures for obtaining emergency services.
    • d. The locations of any providers and hospitals who provide emergency services and services after you are stabilized covered under the contract.
    • e. Your right to use any hospital or other setting for emergency care and services after you are stabilized care services.
19. You have the right to request and receive a copy of your child’s medical records and to request that they be amended or corrected. You get one free of charge.
20. You have a right to have your privacy protected following the privacy requirements in federal law to the extent that they apply.
21. You have the right to exercise these rights without changing the way Delta Dental, providers, or DHS treats you.
22. Your child has the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation as specified in the federal regulations on the use of restraints and seclusion.
23. You have the right to make recommendations about these rights and responsibilities.
24. You have the right to obtain services from an out-of-network provider at no cost only if there is not a Delta Dental Smiles for Kids Network provider that can offer services.

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