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Right To Appeal & ERISA Rights

Payment for services is determined in accordance with the specific terms of your dental plan and/or Delta Dental’s agreements with its participating dentists. Delta Dental’s payment decisions do not qualify as dental or medical advice. You must make all decisions about the desirability or necessity of dental procedures and services with your dentist.

If you have a question regarding your claim, please contact Delta Dental of South Dakota at 1-877-841-1478. If you disagree with the denial, or partial denial of a claim, you or your representative are entitled to a full and fair review of the claim. An appeal must be in writing.

To File An Appeal

Submit your appeal in writing within 180 days of receiving notice of denial or partial denial of your appeal.  Include in the written appeal:

  1. The reason why you disagree with our claim decision.

  2. Documents, records and any other information related to the claim.

  3. The subscriber’s name, identification number, group number and patient’s name on all documents.

Upon your request, we will provide you, free of charge, access to and copies of all documents, records and other information relevant to your claim for benefits.

Within 60 days of receiving your request, we will send you our written decision and indicate any action we have taken. Special circumstances may require additional time. You will be notified within the 60 days if special circumstances require additional review time.

If your benefit plan is governed by ERISA, you have the right to take legal action under Sec. 502 (a) of ERISA following an adverse benefit decision.

Additional information regarding the review and appeal procedure is contained in your benefit plan document.

Send appeals to:

Delta Dental of South Dakota
Attn: Appeal Process
PO Box 1157
Pierre, SD  57501     

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