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Patient: Frequently asked questions

The following are commonly asked dental benefit questions by patients

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Confirmation of treatment & cost


What is a pretreatment estimate?

A pretreatment estimate is also known as a confirmation of treatment & cost and/or predetermination of benefits. This is used to verify coverage of a treatment, as well as receive an estimate of your out-of-pocket cost.

Estimates are recommended for more extensive procedures such as crowns, wisdom tooth extractions, bridges, periodontal surgery, dental implants and dentures.

How do I get a confirmation of treatment & cost before my treatment?

It is easy to get your confirmation of treatment & cost! Make the request to your dentist, who will then send a proposed treatment plan (including relevant X-rays) to Delta Dental. We verify which services are covered under your dental plan and estimate out-of-pocket costs.

A confirmation of treatment & cost, valid for 180 days, will be mailed to you and your dentist qualifying the services covered by your policy and estimate out-of-pocket costs. This document is also posted to your MySmile account.

Need a quicker estimate? Sign in to your MySmile account and use the Cost Genie tool for instant, personalized treatment estimates.

Note that a confirmation of treatment & cost is not a guarantee of payment.

Should I get an estimate before having a dental treatment done?

Yes, we do recommend requesting a confirmation of treatment & cost from your dentist, especially for more extensive treatments such as crowns, wisdom tooth extractions, bridges, periodontal surgery, dental implants and dentures.

A confirmation of treatment & cost will verify the procedures for your treatment that are covered by your benefits and most importantly your estimated out-of-pocket costs. You can also sign into your MySmile account and use the Cost Genie tool for instant, personalized treatment estimates.


Coverage for children


Can our children be covered by more than two dental policies?

Yes, children can be covered by more than two dental benefit policies. They may be covered by one or both parents and one or more stepparents. If either parent's dental policy has a "non-duplication of benefits" provision, the coverage will be subject to contract limitations.

I just had a baby. When should I take him or her to the dentist for their first checkup?

We recommend taking your child to their first dental visit by their first birthday. This helps your child to develop good habits for protecting their smile as they grow.

For more children oral health tips, check out the Washington Dental Service Foundation.

Can my child use the plan while at college?

Yes, Delta Dental network member dentists are available nationwide. You can access a list of dentists located near your child’s college using our Find a Dentist tool.

Note DeltaCare and SimpleChoice plans provide emergency coverage only outside of your service area.

I am divorced. What kind of documentation do I need to provide to Delta Dental to maintain my children's dental coverage?

We accept verbal or written confirmation regarding dual coverage for your children. Please complete and submit a Coordination of Benefits Questionnaire by mail or call us at (800) 554-1907.

What form do I need to view overage dependents information or if I am having custody issues?

Use the HIPAA Authorization form found in the Download forms section.

I am divorced. Whose dental benefits cover our children first if my former spouse and I both have coverage?

It depends on who has financial health care responsibility and/or custody for the children, such as:

If a parent has primary health care responsibility for the children, their coverage will be primary.

If parents have joint health care responsibility, the order of benefits is determined by who has custody.

If both parents have joint health care responsibility and joint custody, the order of benefits is determined by the parent with the birthday earliest in the calendar year as the primary carrier.

I am divorced. Does my former spouse’s dental plan still cover our children if I have physical custody of my children?

If your former spouse’s dental coverage includes dependents, your children have coverage regardless of whether or not they reside with you or your former spouse.


Coverage questions


Can I choose my own dentist?

Yes! There are different networks depending on which Delta Dental plan your employer has selected. To maximize the use of your benefits, find your favorite in-network dentist using our Find a Dentist tool. Enter the criteria important to you, select your plan and search!

You can also read “Choosing a Dentist” in the “How to Use Your Program” section of your dental benefits booklet.

Note DeltaCare patients need to call customer service at (800) 650-1583 to notify changes in their primary care dentists.

Will my dental plan provide coverage when I’m outside of Washington State?

Delta Dental covers you nationwide. Even while you’re out of state on business or traveling with the family, you can find an in-network dentist using our Find a Dentist tool.

Note DeltaCare and SimpleChoice plans provide emergency coverage only when you are outside of your service area.

Do I have to see a primary care dentist to get a referral to a specialist?

For most Delta Dental plans, you may go to any dentist who is a member of the plan to which you belong. If you have chosen the DeltaCare plan however, you'll need to sign up for a primary care dentist by calling the DeltaCare Customer Service Department at (800) 650-1583.

What does non-duplication of benefits mean?

When you're covered by two dental policies, the non-duplication of benefits provision describes how a secondary policy may calculate its portion of payment. The secondary policy pays as much as it would pay if it were primary, minus the primary payment amount.

For example, if the primary policy paid 80 percent and the secondary policy would cover 80 percent if it was primary, the secondary policy would not make an additional payment.

If the primary policy paid 50 percent and the secondary policy would cover 80 percent, the secondary policy would pay up to 30 percent.

Does Delta Dental sell dental benefit plans to individuals and families?

Yes! Check out our affordable individual and family plans. Individual and family plans are available to Washington state residents only. Once you find your plan, you can sign up for dental benefit coverage at DeltaDentalCoversMe.com.

Need child only coverage? You can protect your child’s smile with the Washington Kids Plan. Learn more.


Delta Dental Plans Association (DDPA)


What is DDPA?

Delta Dental Plans Association (DDPA) is a national organization made up of local, nonprofit Delta Dental plans that provide employer groups with dental benefits coverage in all 50 states, the District of Columbia and Puerto Rico.

Will other Delta Dental plans cover my dentist’s fees?

Yes, other Delta Dentals honor the approved fees that member dentists have on file with us.


General Account Questions


How do I create a MySmile account?

To create a MySmile account click the “Sign in or Register” button at the top of the page and then “Register now.” You will need to enter your first and last name, date of birth, email address and the subscriber’s member id number. If you don’t know the subscriber’s member id number, check your id card if you have one, look at a recent explanation of benefits (EOB) statement or call customer service (1-800-554-1907).

How do I change my email preferences, including the email address I provided upon initial registration?

To change your email preferences follow these steps. Sign in with your username and password, then under “My account” choose “Email & communications.” From there you will be able to update your email address, paperless options and change email preferences.

How do I change my password and/or security question?

To change your password and/or security question follow these steps. Sign in with your username and current password, then under “My account” choose “Password & security.” From there you will be able to change your password and update your security question.

I forgot my username and/or password. How can I sign in?

To retrieve your username and/or reset your password follow these steps. Click either forgot username or password adjacent to the Sign in button. Follow the three step process. You will need to enter your first and last name, date of birth, the subscriber’s member id number and the security question associated with your MySmile account. For username, you will also need to enter the email address on file.

I did not get an ID card. How will my dentist know I have coverage through Delta Dental?

An ID card is not necessary to present at your dentist office. Provide your name and subscriber ID number, which the dental office will use to verify eligibility and submit claims. Note your group number is helpful to provide, but is not mandatory.

To obtain a copy of your ID card, you can sign into your MySmile account and print a paper version, email an electronic copy to yourself, send to your iPhone passbook or view on our mobile app.

Why is there only one ID card available in MySmile account?

The ID card available in your MySmile account only lists the primary subscriber on the card, but can be used for all individuals included on the benefit plan.

What is my member ID number?

Your member ID number is a unique number that identifies you as a Delta Dental subscriber under your dental plan. It may be your Social Security Number or a randomly selected identification number that has been assigned.

How can I get approved claim forms?

You can download a standard claim form found in the Download forms section. Here you will also have availability to the out of country claim form.

You can also obtain an American Dental Association-approved claim form from your dentist.

Does it matter if I use all CAPS when creating a MySmile account?

No, you shouldn’t have to use all CAPS to register. However, if you're having difficulty registering, you may try using all CAPS.

Do your Customer Service Representatives speak any other languages?

If English is not your primary language we have interpreters who can help.

How can I access my benefit information through the Delta Dental Interactive Voice Response System (IVR)?

Follow the IVR Phone Prompts to access your benefit information.

How do I change my address with Delta Dental?

Most employers do not allow address changes to be made directly through Delta Dental. Please first request this change through your employer.

If you have a Delta Dental Individual Plan you can update your address by logging into DeltaDentalCoversMe.com and updating your profile.

What is the mailing address for Delta Dental claims?

Delta Dental member dentists will submit your claims for you. In the case you visit a non-member dentists, please send your claims to:

Delta Dental of Washington
P.O. Box 75983
Seattle, WA 98175

How do I set my pop-up blocker settings?

For Internet Explorer browsers:

  • Go to "Tools" in navigation
  • Select "Popup Blocker" settings
  • Add *.deltadentalwa.com and *.deltadental.com as trusted sites
  • Click “Close” once trusted sites are added

For Firefox browsers:

  • Go To "Tools" in navigation
  • Select "Options"
  • Click on "Content" in top navigation of the gray popup box
  • Click on "Exceptions" next to Popup Blocker
  • Add *.detladentalwa.com and *.deltadental.com as trusted sites
  • Click "Ok" to complete


Member Dentist Information


What is a Delta Dental “member dentist?”

Delta Dental member dentists have signed an agreement stipulating that he or she will provide dental treatment to patients covered by Delta Dental's group dental care programs. Benefits of seeing a member dentist are:

  • Offers the lowest possible fees
  • Held to Delta Dental’s maximum allowable fee for a participating provider
  • Submits your dental claims directly to Delta Dental for you
  • Only charged, up front, the expected co-pay and deductible

Note this applies only to Delta Dental PPO and Premier plans.

What is the difference between a Delta Dental Premier® and Delta Dental PPO dentist?

Delta Dental Premier is our traditional fee-for-service plan. All Delta Dental member dentists automatically belong to this network.

Delta Dental PPO is our preferred provider plan and has the largest network of PPO dentists in Washington. PPO network dentists have agreed to provide care based on a lower average fee schedule.

My dentist said that he or she takes Delta Dental, but my claim did not pay as expected.

Any dentist can choose to accept payment from a benefits carrier, but that does not guarantee that they are in your plan’s network. To find a dentist you know is in-network, use our Find a Dentist tool before scheduling an appointment.


Treatment coverage questions


How many teeth cleanings do my benefits cover per year?

This is dependent on your type of dental plan that was purchased by your employer. Check your dental coverage by signing into your MySmile account. Note that your benefits refer to a teeth cleaning as Prophylaxis.

Are sealants covered on restored molars?

Sealants are covered on permanent molars with no restorations or decay on the occlusal surface.

Why did Delta Dental pay less for white fillings on my back teeth?

Your plan has an alternative allowance for fillings on your back teeth. If you have a white or tooth-colored filling placed on a back tooth, your plan will cover what a silver filling would cost. The difference in the cost between the silver and the white filling is your responsibility.

Plan ahead and find out your estimated out-of-pocket costs ahead of time. Request a predetermination from your dentist that is valid for 90 days. Or you can also sign in to your MySmile account and use the Cost Genie tool for instant, personalized treatment estimates.


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