Visiting a dentist outside the Delta Dental network

Delta Dental Premier® and Delta Dental PPOSM plans allow you to select any licensed dentist. We recommend you select a Delta Dental dentist because you may enjoy lower out-of-pocket costs and Delta Dental dentists agree never to charge you more than the fees determined by Delta Dental. If you choose to visit a dentist outside of the Delta Dental network, you will likely have to submit claims yourself and pay the entire bill up front.

If you are enrolled in DeltaCare® USA, our prepaid dental plan, you must receive treatment from your assigned primary care DeltaCare USA dentist.1 Treatment provided by another dentist, even if he or she participates with the DeltaCare USA plan, usually is not covered, unless the dentist is a specialist referred by your assigned primary care dentist.

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Forms

Claim Forms

Delta Dental PPO and Delta Dental Premier claim forms by administrator.

DeltaCare USA claim and encounter forms.

Claim forms for AARP Dental Insurance Plan.

Tip

How To File
A Dental Claim

Dentists who accept Delta Dental will file claims for you. You only need to file a claim when visiting a non-Delta Dental dentist.

Customer Service Forms

For fastest response, select the form for the company through which you receive benefits.

Grievance Forms by Program

We urge you to communicate directly with your dentist. If you cannot obtain a satisfactory resolution, file an online grievance report or call customer service.