Member: Frequently asked questions

What is a pre-treatment estimate?

A pre-treatment estimate is also known as a confirmation of treatment & cost or a predetermination of benefits. Pre-treatment estimates give an approximate idea of how much a dental treatment will cost overall and what to expect for an out-of-pocket cost.

Pre-treatment estimates are recommended for more extensive procedures such as crowns, wisdom tooth extractions, bridges, periodontal surgery, dental implants and oral surgeries.

How do I get a pre-treatment estimate before my treatment?

Ask your dentist to submit a pre-treatment estimate to Delta Dental. Delta Dental will review the proposed treatment based on the type of plan you have, your eligibility, your current plan benefits and the amount remaining in your annual maximum.

A pre-treatment estimate Explanation of Benefits (EOB), will be mailed to you and your dentist confirming the services covered by your policy, explaining how much Delta Dental will pay and showing your estimated out-of-pocket costs. You can also find this document on your member portal.

Need a quicker estimate? Sign in to your member portal account and use our Dental Care Cost Estimator for instant, personalized treatment estimates.

Please note: Pre-treatment estimates are based on eligibility and the plan design on the date the estimate is processed and are not guaranteed for future benefits.

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

Yes, we recommend requesting a pre-treatment estimate from your dentist for services that typically cost over $300, such as crowns, wisdom tooth extractions, braces, bridges, dentures and oral surgery.

Pre-treatment estimates help you make informed decisions about your health care dollars.

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.

Delta Dental follows a legal procedure called Coordination of Benefits (COB) to establish which dental plan is primary and how much the secondary plan should pay.

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, or within six months after their first tooth comes in. Early visits help empower healthy habits and set the foundation for a lifetime of great oral health.

For more oral health tips, check out our Life Stages Resources.

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.

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

For children of divorced or separated parents, benefits are determined in the following order unless a court order places financial responsibility on one parent:

1. The plan of the custodial parent
2. The plan of the custodial parent’s new spouse (if remarried)
3. The plan of the noncustodial parent
4. The plan of the noncustodial parent’s new spouse (if remarried)

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

Can I choose my own dentist?

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

Is there a provider located near me?

Delta Dental has the largest network of providers in Massachusetts and nationwide, so you are sure to find one near your home or work. Use our Find a Dentist tool to search by your city or zip code and find an in-network dentist near you.

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

Yes. 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.

How do I submit a claim?

Download a claim form from your secure member portal. Fill out the claim form. You will need the ADA Procedure codes (provided by your dentist's office), along with your provider's information and TIN (tax identification number). If available, please attach a copy of your bill as well.

Mail your completed claim form to:

Attn: Claims
Delta Dental of Massachusetts
P.O. Box 75688
Seattle, WA 98175

How do I submit an out-of-country claim?

Delta Dental of Massachusetts provides benefits for services performed out of the country. If you see a dentist outside of the United States, you are responsible for obtaining the necessary documentation for services provided. The following information needs to be submitted:

• Itemized bill from the dentist converted to U.S. currency based on the date of service
• A completed claim form with subscriber identification number and the group number
• English translation of all materials

Mail your itemized bill, completed claim form and translated materials to::

Attn: Claims
Delta Dental of Massachusetts
P.O. Box 75688
Seattle, WA 98175

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.

Is there a waiting period for my plan?

There may be. The waiting period is a length of time a member must be enrolled in a plan before becoming eligible to receive benefits for all or certain treatments. Waiting periods vary by plan and some plans do not have waiting periods. You can determine whether your plan has a waiting period and how long it is by calling 800-872-0500 or logging on to our member portal to view your plan coverage information.

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 Massachusetts residents only. Once you find your plan, you can sign up for dental benefit coverage at DeltaDentalCoversMe.com

Does Delta Dental offer plans for seniors and retirees?

Delta Dental offers a plan specifically for seniors called the Delta Dental Individual and Family™ PPO Value for Seniors. The plan provides comprehensive oral health coverage designed to empower the smile – and the health – of people age 65 and older.

Seniors and retirees have other options as well since they are eligible for any Delta Dental Individual and Family™ plans. Shop and compare plans to find the one that’s right for you.

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.

How do I know what type of plan I have?

Your plan name is listed on your ID card. If you need a new card, call 800-872-0500 or submit a request via our member portal message center.

How do I create a member portal account?

To create an account in the member portal, 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 give us a call 800-872-0500 .

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 member portal. For the 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’s 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 member portal and print a paper version, email an electronic copy to yourself, send to your iPhone passbook or view on our Delta Dental Mobile App. You can also call Customer Service at 800-872-0500 to request a replacement ID card.

Why is there only one ID card available in the member portal?

The ID card available in your member portal 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.

Do your Customer Service Representatives speak any other languages?

Yes. 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.

Follow the IVR Phone Prompts to access your benefit information.

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 Massachusetts
P.O. Box 75688
Seattle, WA 98175

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:

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

Delta Dental Premier is our traditional fee-for-service plan. With this plan, members have access to the largest national network, with 3 out of 4 dentists participating nationwide.

Delta Dental PPO is our preferred provider plan. With this plan, members receive the lowest out-of-pocket costs.

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.

How many teeth cleanings do my benefits cover per year?

This depends on your type of dental plan that was purchased by your employer. Check your dental coverage by signing into your member portal.

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 pre-treatment estimate from your dentist.