Frequently Asked Questions
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How do I pick a dentist that's right for me?
Your relationship with your dentist is very important, and you'll want to find a dentist who makes you feel comfortable and with whom you can openly discuss your oral health concerns.
Because you never know when you might have a dental emergency, it's important to begin building a relationship with a dentist now so you'll be prepared if you need urgent dental care.
It's also a good idea to contact a few dental offices to determine who you feel most comfortable with. Ask the following questions:
- What are the office hours? (You want to be sure the office is open at times that suit your schedule.)
- How does your office handle dental emergencies?
- Do you explain dental procedures and the associated costs before providing the service?
- What is your approach to providing dental care—are you proactive or more conservative in your treatment?
- Do you provide dental health education tips and training on personal oral health care?
- Do you screen for oral cancer and other diseases?
For good sources for dentists' names and business locations, you can:
- Search Delta's on-line Find a Dentist Directory
- Contact your state's dental society for referrals.
- Ask your friends and family which dentists they use, and whether they are satisfied.
You may also check with the Commonwealth of Massachusetts Division of Licensure to see if a dentist holds a current license and if he/she had any disciplinary actions in the past.
And so you'll enjoy the greatest value from your Delta Dental plan, ask the dentist if he or she participates in the Delta Dental plan to which you belong.
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How can I find a participating dentist near where I live or work?
Please check Find A Dentist on our website. You will need to know if your dental plan is Delta Dental Premier, Delta Dental PPO, DeltaCare, or the Value Plan program. Just check your ID card for the name of your plan. Then enter in either your zip code or city (not both please). A list of participating dentists will be displayed on your screen that can also be printed out. You may also get a map with driving directions to the participating dentist by clicking on their practice address.
If you participate in the Massachusetts Public Employees Fund Open Plan, please select Delta Dental Premier as your plan and follow the directions above. If you participate in the Massachusetts Public Employees Fund Closed Plan please call 1-800-553-6277 to find a participating dentist.
Another way to find out if a dentist participates is to contact our Customer Service departments.
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What is an annual maximum and deductible?
An annual maximum is the maximum amount your dental plan will pay in benefits during the calendar year or plan year. Most companies select calendar year, which is January 1st through December 31st, however some select a plan year that corresponds to when their group's benefits renew (or open enrollment).
A deductible is the dollar amount of covered dental expenses you must pay during the year before plan benefits are paid and normally applies to Type II and Type III services. The deductible can be set on either a calendar or plan year.
Please refer to your member benefit materials or contact our Customer Service departments to confirm your calendar or plan year dates.
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When I visit a participating dentist do I have to bring a claim form?
No, participating dentists will submit claim forms for you. However, if you visit a non-participating dentist, you may need to complete a claim form and forward it to us for payment. Click here to download a copy of our Claim Form.
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I tried to download a Claim Form and received an error message?
In order to view any of our forms on-line, you will need to have Adobe Acrobat installed on your computer. You may install Adobe Acrobat for free by clicking here and following the instructions listed on Adobe's website. After you have completed your download, please return to the Forms section of our website and click on the Claim Form. The form should now load and print for you.
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How long will it take to process my claim?
Over 90% of claims processed through our automated claims system are paid in less than 15 business days if they are complete and eligibility can be verified. If you have a patient responsibility you will receive an Explanation of Benefits (EOB) notification that summarizes the services you received, the amount we paid the participating dentist and your co-payment and/or deductible amount (if applicable).
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I received an Explanation of Benefits notification. What is this?
An Explanation of Benefits (EOB) notification summarizes the dental services you received. We mail an EOB to the participating dentist and subscriber if they have a patient responsibility. The EOB lists the claim number, a description of services, the dentists' charge, Delta Dental's payment and the patient responsibility (co-payment and/or deductible if applicable).
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Do I need a referral if I visit a specialist?
If you are a member of Delta Dental Premier, Delta Dental PPO (PPO), or the Massachusetts Public Employees Fund Open Plan you do not need a referral to receive care from a specialist. However, we strongly encourage you to utilize the services of a network specialist to maximize your benefit coverage. If you need help locating a specialist in your area, please contact our Customer Service Departments.
If you are a member of the Massachusetts Public Employees Fund Closed Plan, you do not need a referral to visit a specialist—however, you do need to receive your care from a participating Massachusetts Public Employees Fund Closed Plan specialist. If you need assistance locating a closed panel specialist, please call 1-800-553-6277.
If you are a DeltaCare member and are in need of specialty services, you may select a specialist from the DeltaCare network or ask your primary care dentist for a recommendation. However, to receive the maximum value from your benefits, you must receive services from a participating DeltaCare specialist.
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How do I verify that I have been enrolled for dental coverage?
Please check with your company's Benefits Administrator first to find out if you have been in enrolled in one of our plans. If you are a member of Delta Dental Premier, Delta Dental PPO, the Massachusetts Public Employees Fund or Group Insurance Commission plans you can click on the eligibility link within the Members section and register for our Online Services. Once you register you'll be able to view your benefits, check claim status and verify your deductible and remaining annual maximum. To register, simply enter in your Subscriber ID number (typically your Social Security number), last name, and date of birth. Or you may contact our Customer Service Voice Response Unit (VRU) at 1-800-872-0500 to verify coverage and eligibility. You will need to enter in your subscriber ID number (typically your social security number) and date of birth.
The VRU is available Monday through Friday from 7:00 AM to 11:00 PM EST and on Saturday from 7:00 AM to 3:00 PM.
If you are a DeltaCare or Value Plan member please call 1-800-327-6277 to verify coverage and eligibility.
If you are a member of the Massachusetts Public Employees Fund or Group Insurance Commission plan and have a question please call 1-800-553-6277 to speak with a Customer Service representative.
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How do I find out what my benefits are?
You can click on the benefit inquiry link within the Members section and register. To view your benefits, check claim status and verify your deductible and remaining annual maximum. To register, simply enter in your Subscriber ID number (typically your Social Security number), last name, and date of birth. You will also receive a copy of your subscriber benefits from your Benefits Administrator during enrollment. Or contact our Customer Service Voice Response Unit at 1-800-872-0500 if you belong to Delta Dental Premier, Delta Dental PPO, Massachusetts Public Employees Fund or Group Insurance Commission plans. For DeltaCare and Value Plan coverage information, call 1-800-327-6277.
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I speak a foreign language; do you have translation services available?
Yes, we offer a foreign language translation service through our Customer Service Departments. With the help of the AT&T Language Line, Delta Dental of Massachusetts communicates in 140 different languages. Simply contact our Customer Service Departments to request a translator.
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My benefits come through COBRA. Who takes care of them?
Delta Dental of Massachusetts complies with COBRA rules and regulations and accepts existing COBRA participants. We do not, however, assume the employer's responsibility for notifying, billing and administering COBRA legislation.
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I'm covered under two dental plans. How will you handle my coverage?
If you and your family are covered by more than one dental plan (or a medical plan that offers dental coverage), Delta Dental will coordinate benefits with the other carrier. In determining coverage, total payments from both carriers cannot exceed the billed charge for the service. If you have a question about Coordination of Benefits (COB), please contact our Customer Service department at 1-800-872-0500.
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I lost my ID card. How do I get a replacement?
You may print a replacement ID card by clicking on the Print a new ID Card Request link. If you are not already registered for our Online Services you'll need to click on the register now button. To register simply enter in your Subscriber ID number (typically your Social Security number), last name, and date of birth. Or you may contact our Customer Service departments. You will need to have your subscriber ID number and group number handy.
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What is a pre-treatment estimate?
While they are not required, we encourage subscribers to request that their dentist file a pre-treatment estimate for any procedure that is expected to cost more than $300. Pre-treatment estimates help subscribers determine their out-of-pocket expenses for costly procedures before they begin treatment.
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