Additional Information about Oral Health
American Dental Association
Delta Dental Plans Association
Participating Dentists' Network
You will get the best value from your program when you receive your dental care from one of Northeast Delta Dental's Participating Dentists:
No Balance Billing: Because participating dentists accept Delta Dental's approved amount for service, you may have lower, out of pocket expenses when you visit a participating dentist.
Less Paperwork: Participating dentists will prepare and submit claims for you.
Direct payment: Northeast Delta Dental pays the dentist directly, so you don't have to pay the covered amount up-front and wait for a reimbursement check.
To find out if your dentist is part of the Northeast Delta Dental network, call your dentist or visit our web site at www.nedelta.com. You can also call our Customer Service Department at 1-800-832-5700 or 603-223-1234.
Claim Submission Process for Participating Dentists
Present your subscriber ID card to the dentist at the time of your visit.
The dentist will submit your claim to Northeast Delta Dental.
Northeast Delta Dental will send you an EOB (Explanation of Benefits) detailing what has been processed under your programs coverage. You are responsible to pay any remaining balance directly to the dentist.
Claim Submission Process for Non-Participating Dentists
If you visit a non-participating dentist, you may be requested to bring a claim form that is available by calling Northeast Delta Dental or can be downloaded from www.nedelta.com. Payment will be made to you, the Subscriber, unless the state in which the services are rendered requires that assignments of benefits be honored and Northeast Delta Dental receives written notice of an assignment on the claim form before payment for benefits is made. Payment for treatment performed by a non participating dentist will be limited to the lesser of the dentist’s actual submitted charge or Delta Dental’s allowance for non-participating dentists in the geographic area in which services are provided. It will be your responsibility to make full payment to the dentist. When there is not sufficient fee information available for a specific dental procedure, Northeast Delta Dental will determine an appropriate payment amount.
Foreign Claim Information
Your plan allows you to see any dentist, whether it is your family dentist or whether it is a dentist treating a dental emergency that crops up on vacation. If you do see a dentist while out of the country, just fill out a claim form and submit it. Follow these instructions on filling out a foreign claim form.
Predetermination of Benefits
Northeast Delta Dental strongly encourages predetermination of cases involving costly or extensive treatment plans. Although it's not required, predetermination helps avoid any potential confusion regarding Delta Dentals payment and your financial obligation to the dentist.
Coordination of Benefits
When a covered individual under this program has additional group dental coverage, the COB (Coordination of Benefits) provision described in your Dental Plan Description booklet will determine the sequence and extent of payment. If you have any questions about COB, please contact our Customer Service department at 1-800-832-5700 or 603-223-1234.
Two subscriber identification cards from Delta Dental will be produced and distributed shortly after your enrollment. Both cards are issued in the subscriber's name, but can be used by everyone covered under the program.
Dental Plan Description Booklet/Outline of Benefits
Depending on your group structure, you may receive a Dental Plan Description booklet containing an Outline of Benefits shortly after your enrollment or you may obtain the Dental Plan Description through your employer intranet. This booklet describes the benefits of your program and tells you how to use your plan. Please read it carefully to understand the benefits and provisions of your Northeast Delta Dental program.
Guarantee Of Service ExcellenceSM Program
Northeast Delta Dental is committed to providing extraordinary service to all of its customers. We believe that when our people are inspired to pursue excellence in order to achieve a higher level of customer satisfaction, all of those who share in Northeast Delta Dental will benefit. To emphasize our commitment, we guarantee seven major areas of service to our clients and reinforce them by our comprehensive group refund policy.
If you have further questions, please contact Northeast Delta Dental's Customer Service department at 1-800-832-5700 or 603-223-1234.