As a Delta Dental Smiles 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, you have these rights:
- You have the right to be treated with respect, dignity, and privacy.
- You have the right to receive care no matter how you identify your race, color, nationality, disability, sex, religion, or age.
- You have the right to get correct, easy-to-understand information to help you make healthy choices.
- You have the 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.
- You have the right to file an appeal about an action or decision we make.
- You have the right to know:
- a. Why Delta Dental decides to cover or not cover a service.
- b. Why Delta Dental decides if a service is medically necessary.
- c. Who in Delta Dental’s office decides these things.
- You have the right to know the names of Delta Dental Smiles Network dentists.
- You have the right to pick from a list of dentists to get the right kind of care for you.
- You have the right to take part in all your dental care decisions. This may include refusing treatment.
- You have the right to get a second opinion, at no cost, from another Delta Dental Smiles 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.
- You have the right to fair treatment from us, Delta Dental Smiles Network dentists, and other dentists.
- You have the right to:
- a. Talk to a dentist in private.
- b. Have dental records kept private.
- c. Request a copy of dental records.
- d. Ask for changes to those records.
- You have the right to know dentists who can inform you about:
- a. Health status.
- b. Dental care.
- c. Treatment.
- You have the right to know you are not responsible for paying for covered services. Delta Dental Smiles Network dentists can’t require you to pay for your covered services.
- 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.
- You have the right to get a spoken translation at no cost for all non-English languages, not just those identified as prevalent.
- You have the right to recommend changes in policies and services under Delta Dental Smiles. Write us or call toll-free at 1-866-864-2499.
- You have the right to get detailed information about emergency and after-hours coverage. This includes, but is not limited to, information about:
- 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.
- You have the right to request and receive a copy of your medical records and to ask that they be amended or corrected. You get one free of charge.
- You have the right to have your privacy protected following the privacy requirements in federal law to the extent that they apply.
- You have the right to exercise these rights without changing the way Delta Dental, providers, or DHS treats you.
- You have 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.
- You have the right to make recommendations about these rights and responsibilities.
- 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 Network provider that can offer services.