We collect personal information to administer your dental benefits program. This information may include (but is not limited to) your name, address, identification number, and information about your dental history. You are the primary source of this information. We also collect information from a variety of other sources, however. For example, we may collect:

• Enrollment information from your employer or group, insurance agents, brokers, or consultants.
• Information about your dental health and condition from dentists and other professionals and their office personnel.
• Dental and medical claims and payment information other dental insurers, health insurers, HMOs, and similar organizations with which you may have other dental, hospital, medical or related coverage.

 

We typically collect this information from your application, group enrollment form, claims submitted by you or your dentist, direct personal contact, correspondence, telephone, facsimile, or electronic communications. We may collect “personal information,” which is any individually identifiable information that is gathered in connection with your dental services program and from which judgments can be made about your character, occupation, health, or other personal characteristics. It may include your name, address, and medical or dental information, but does not include “privileged information.” We also may collect “privileged information,” which is any individually identifiable information that relates to, is collected in connection with, or is collected in reasonable anticipation of a claim or civil or criminal proceeding.

We do not disclose any of the information described under "Our Collection Practices" except as permitted by State and Federal law. This applies to information about our former as well as current customers. For example, we are permitted to disclose personal information without your authorization to:

• Dentists, other professionals, and dental office personnel to verify insurance coverage or benefits, including payment of claims.
• Companies that contract with us to perform insurance and insurance-related services (such as companies that write checks or mail identification cards, process data, and develop or maintain software).
• An agent, broker, or consultant who provides you (or your employer) with information about Delta Dental of Virginia or your group dental benefits program.
• Dentists and other non-employee professionals who review claims for us or who are involved with claims appeals.
• Other Delta Dental plans that provide services outside Virginia and other health insurers, HMOs, and similar organizations for the purpose of (a) coordinating benefits or (b) preventing, detecting, or prosecuting criminal activity, fraud, material misrepresentations, or material nondisclosure in connection with enrollment or insurance activities.
• Your employer or group for the purpose of explaining how we paid claims and carried out our other responsibilities under the group contract or for audits.
• Insurance regulatory, law enforcement, and similar government authorities.
• Other third parties as permitted by the HIPAA Privacy Rule.

You may submit a written request to us for access to your personal information. Our address is in the last section of this notice. You must describe the information that you seek in reasonable detail. You should include your name, address, and identification number and identify your dentist and dates of service, if applicable. We can accommodate your request if we can locate and retrieve the information you ask for in a reasonable time and manner. We may ask you for proper identification to safeguard your personal information.

Within 30 days of your request, we will:

• Inform you of the nature and substance of the recorded personal information in writing, by telephone, or by other oral communication.
• Permit you to see and copy, in person (by appointment only), your personal information or provide you with copies of this information by mail, whichever you prefer. If the information is in coded form, we will provide a written plain language explanation.
• Identify the persons to whom the personal information has been disclosed within the last two years (if we recorded the disclosure). If we have not recorded disclosures, we will provide you with the names of persons to whom this information is normally disclosed.
• Permit you to correct, amend, or delete your recorded personal information in the manner provided for in the next section “Your Right to Correct Personal Information.”

 

We may deny your request in limited circumstances. Your access right does not extend to privileged information. We may charge a reasonable fee for copies of your information.

You may request that we correct, amend, or delete personal information that we have if you believe it is inaccurate or incorrect. You must make this request in writing. Our address is in the last section of this notice. To assist us, you must describe the information that you wish us to correct in reasonable detail and explain why it is inaccurate or incorrect. You must include your name, address, and identification number. You should also identify your dentist and dates of service, if applicable.

Upon receipt of your written request, we will investigate the information you believe is incorrect or inaccurate. Within 30 days of our receipt of your written request to correct, amend, or delete personal information that we have, we will:

• Correct, amend, or delete the inaccurate or incorrect portion of your personal information; or
• Notify you that we refuse to make the correction, amendment, or deletion; the reasons for our refusal; and your right to file a statement of disagreement.

 

If we agree to your request, we will notify you that we have done so. We will also send the correction to any person you designate who may have received the incorrect information in the last two years. If we do not agree to your request, you may send us a concise statement describing the information that you believe is correct, relevant, or fair, and the reasons why you disagree with our refusal to change it. When we receive this statement of disagreement, we will:

• Place it in our file with the disputed personal information so that anyone reviewing the information will have access to it;
• Clearly identify the disputed personal information and provide the statement along with the information in any subsequent disclosure; and
• Furnish the statement to any person you designate who, within the preceding two years, may have received what you believe to be incorrect personal information.

 

Your right to correct, amend or delete recorded personal information does not extend to privileged information.

Delta Dental of Virginia believes in a subscriber’s right to privacy with regard to his/her dental services plan records and dental history. We support an individual’s right to access his/her records and information in our possession pertaining to claims submitted for care and services. In accordance with current federal and state regulations, we strive to protect this information and allow access to personal information to the limited extent necessary for treatment purposes, patient knowledge, claim processing, and as otherwise permitted or required by law.

We restrict access to personal information to our employees, consultants, and outside vendors who need to know the information to provide products and services to our subscribers. We maintain physical, electronic, and procedural safeguards that comply with federal and state laws to guard against non-permitted and unauthorized disclosures. If you have any questions about our procedures or information maintained about you, please contact us at the following address (be sure to include your name, address, and subscriber identification number):

Delta Dental of Virginia
ATTN: Privacy Officer
4818 Starkey Road
Roanoke, VA 24018

You may also contact us by calling toll-free at: 800-237-6060.