Help Center: Members

Benefits

Where can I get information about my benefits?

You can access your benefits information 24/7 by logging into our member portal and downloading your Member Handbook/Evidence of Coverage (EOC) booklet. If you have questions about your benefits, you may also contact our Benefit Services Department online or at 800-237-6060.

Can I get a listing of the allowed amounts for covered procedures?

Your dentist can submit a pre-determination for services to be performed. This allows you to know what the out-of-pocket expense will be before services are rendered. In addition, you can now look up average charges for dental procedures before you even visit the dentist using our new cost estimator! Log in to use our cost estimator.

Will my spouse or covered dependents get an ID card with their name on it?

All cards issued will bear only the subscriber's name. However, the card will indicate whether or not the policy has spousal or family coverage. Log in to print additional ID cards.

How can obtain additional copies of my ID card?

Log in as a member to print additional copies of your ID card, call us at 800.237.6060, or download the Delta Dental mobile app to save an electronic version on your Apple or Android device. 

What is a pre-determination?

A pre-determination is a plan of treatment, completed by your dentist, for services that will be provided at a future date. You and your dentist will receive a reply as to whether the treatment plan is covered under your group’s benefits. You will also receive an estimated dollar amount for the planned procedure. A pre-determination is recommended when dental services are expected to cost $250 or more. A pre-determination is valid for 90 days and is subject to eligibility, benefit maximums, group and dentist status at the time services are provided.

Do I need pre-approval for major dental work?

We do not require a pre-approval for services received, but we recommend it for any non-emergency treatment plan of $250 or more. Please discuss this option with your dentist.

Do Delta Dental's plans cover cosmetic dentistry and orthodontics?

Cosmetic services are not covered under Delta Dental’s group dental plans. Please log in to view your Member Handbook/Evidence of Coverage (EOC) to see if orthodontics are covered under your plan. You may also contact our Benefit Services Department at 800-237-6060 to review your group’s dental benefits.

Where can I submit a change of address?

Inform your Human Resources/Benefits Department of your new information.

Who should I notify if I have a life status change such as marriage, divorce or death?

Contact your Human Resources/Benefits Department and inform them that you would like to add or terminate a dependent.

Can I purchase individual coverage?

Delta Dental of Virginia offers individual dental plans for residents in the state of Virginia who are not eligible for dental coverage through an employer. For more information on our individual plans and to enroll online, visit DeltaDentalCoversMe.com.

Claims and Reimbursement

How can I check the status of my claim?

You can check your claims history by logging into our member portal or by calling our Benefit Services Department at 800-237-6060. Because of the large volume of claims received each day, please allow 10 - 14 business days for processing before contacting Benefit Services to confirm receipt of your claim.

Do I need to submit a claim after receiving treatment or will my dentist handle it?

If you receive treatment from a participating dentist, they will file all claim information for you. However, you are responsible for submitting claim information if you visit a non-participating dentist. All claims must be submitted within twelve (12) months of the date services are completed. If the claim is for Orthodontic services, the claim should be filed at the time of the banding. New enrollees who are already in Orthodontic treatment when this coverage becomes effective or after a benefit waiting period is met, should file a claim upon enrollment or once the benefit waiting period has been satisfied. If you visit an out-of-network dentist and need a claim form, call us at 800-237-6060.

 

Where do I send a claim?

Claims can be mailed or faxed to:

Delta Dental of Virginia 
Attn: Claims Department 
4818 Starkey Road 
Roanoke, VA 24018 
Fax:540-491-9717

How can I find out how much I owe for dental services?

To see how much you owe, log into our member portal, where you can access detailed benefits information and any Explanation of Benefits (EOB) you have received for your dentist visits.

How will I be reimbursed?

When you visit a dentist that participates in the Delta Dental network covered by your plan, your claims will be filed for you. You may be responsible for any coinsurance and/or deductible due to the dentist on the day of your appointment. If you choose to visit a non-participating dentist, you may be responsible for all payments and charges to the dentist at the time of treatment. You may also be responsible for submitting the claim form to Delta Dental of Virginia. In most cases, Delta Dental will send you reimbursement for the covered services. 

I work out of the United States. Will you accept a claim that is out of the country?

Yes, we will accept your dental claim from any dentist around the globe.  However, you may be responsible for sending the claim to Delta Dental or possibly to your employer. You may submit your claim directly to us at the address below.

Delta Dental of Virginia
4818 Starkey Road, Roanoke VA 24018
ATTN: Claims Department

Can I appeal to have my denied claim reviewed again?

Yes, if you are not satisfied with our response you may request that your dental office appeal the decision. Two appeals are allowed. The first appeal must be received within 180 days of the date of the check or the original claim denial. The dental office has 60 days from the date of the first appeal denial letter to file the second appeal. 

Visiting the Dentist

What are the advantages of visiting a dentist that participates with Delta Dental?

Visiting a Delta Dental participating dentist will provide you with higher cost savings, as dentists who participate with us have agreed to accept our allowances as payment for the services provided under your plan. Participating dentists will also file all claims for you, meaning you will only be responsible for any coinsurance and/or deductible at the time of your visit.

If you choose to visit a non-participating dentist, you may be responsible for all payments and charges to the dentist at the time of treatment, and you may be balanced-billed for the difference in the cost of services provided. You may also be responsible for submitting the claim form to Delta Dental of Virginia.

Check the top right-hand corner of your ID card to see which network is covered by your plan and use our Find a Dentist search to find a participating dentist.

How do I find a Delta Dental participating dentist or check to see if my current dentist is a Delta Dental participating dentist?

Simply use our Find a Dentist search to find a dentist that participates in the Delta Dental network covered by your plan or to see if your dentist already participates.

My dentist does not participate with Delta Dental. Can I still visit him or her?

You may visit a dentist that does not participate with Delta Dental if your plan covers out-of-network services; however, your out-of-pocket costs will be higher if you visit a non-participating dentist. You will be responsible for the difference between what your Delta Dental plan covers and the non-participating dentist's charge, plus any coinsurance and/or deductible.

Please check the upper right-hand corner of your Delta Dental ID card. If the following appears, then you do have out-of-network coverage:

  • Delta Dental PPO™
  • Delta Dental Premier®
  • Delta Dental PPO plus Premier™

If you see the following, then you do not have out-of-network coverage:

  • Delta Dental PPO™ - Pays PPO Network Only
  • Exclusive Provider Network (EPN)
  • Delta Dental PPO™ - EPO Plan Design

If you have questions, please call our Benefit Services department at 800-237-6060.

How do I change dentists?

If your plan is covered by the Delta Dental PPO™ or Delta Dental Premier® networks, simply make an appointment with your new dentist of choice. Use our find a dentist tool to search for a new dentist. 

How can I recommend that my dentist participate with Delta Dental?

To recommend a dentist for participation in one of the Delta Dental networks, fill out the approprate form below.

You can also call our Benefit Services Department at 800-237-6060 or have your dentist contact Delta Dental of Virginia directly.

I have a policy from Delta Dental of Virginia but I live in a different state. Do I have to see a dentist in Virginia?

If you are a resident of another state, you are not required to see a dentist in Virginia. Find a Dentist who participates in your plan. 

What if I am unhappy with the dental care I received or wish to file a grievance?

If you have a complaint regarding quality of care issues, please detail it in writing and mail to:

Delta Dental of Virginia
Attn: Appeals Department
4818 Starkey Road
Roanoke, VA 24018