You have the right to appal a claim denied in whole or in part.
We encourage you to contact Customer Service at 877-841-1478 to discuss the matter and allow us to explain how to appeal a denied claim.
In most cases, your dental provider will submit a "reconsideration" of the denied claim at your request to Delta Dental of South Dakota. This will include additional clinical information to support the eligibility of the procedure for coverage and payment.
If the claim is denied following reconsideration, you may formally appeal the denial. Formal appeals can be submitted by you or your dental provider. The process includes set timelines, requires specific documentation, and will be reviewed by an independant dental consultant.
Details about reconsiderations and appeals are available in your Dental Benefits Handbook. Sign in or create an account at the Members webpage to download a copy of your handbook and see other plan information.