Benefits and Claims
We do not require a pre-approval for services received, but we recommend a predetermination of the claim for any non-emergency treatment plan of $300 or more. This predetermination of benefits informs you and your dentist, before the procedure is performed, if it is a covered procedure and what the reimbursement for the covered procedure will be. Please discuss this option with your dentist.
If you receive treatment from an in-network dentist, they will file all claim information for you. However, you may be responsible for submitting claim information if you visit a non-participating dentist.
Cosmetic dentistry is not covered by Delta Dental®. Orthodontia is covered by some group plans. Please review your benefits to see if orthodontia coverage is available under your plan. You may also contact Customer Service at 1-800-462-5410 for information
on your dental benefits.
After you visit your dentist, you will receive an Explanation of Benefits. The Explanation of Benefits will display the fee your dentist submitted, the amount Delta Dental will cover and the amount you owe for the service. If you owe any amount, you will need to pay your dentist the remaining balance. You may also access your Explanation of Benefits when you login to the Member Portal using the login button at the top of this website.
There are several ways to recommend a dentist. If you receive your dental coverage through your workplace, you can contact your Human Resources/Benefits Department and submit the dentist’s name. You can also call our Professional Relations Department
at 1-800-462-5410. The dentist can also contact Delta Dental of Arkansas directly.
You have the right to appeal a denied claim. Appeals must be submitted within 180 days of the date on the notice of the claim denial. Please state why the claim should not have been denied and include the denial notice and any other documents, information or comments you believe may have an influence on the appeal of the claim. Delta Dental will send you a response within 60 days of your notice of appeal. Please send your appeal to:
Delta Dental of Arkansas
Attn: Customer Service Support
P.O. Box 15965
Little Rock, AR 72231
Delta Dental of Arkansas
Attn: Customer Service Support
P.O. Box 15965
Little Rock, AR 72231
Simply make an appointment with your new dentist of choice. To see if the dentist is a Delta Dental Participating Dentist, use our Find a Dental Provider tool.
You can view a listing of Delta Dental dentists online by visiting the Find a Dental Provider tool. You can also call Customer Service at 1-800-462-5410.
An in-network dentist will file your claim and be reimbursed directly by Delta Dental of Arkansas. You may be responsible for any co-insurance, co-payment, and/or deductible due the dentist. 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 Arkansas. If you file a dental claim, Delta Dental will send you reimbursement for the covered services in most cases.
Yes, you have the freedom to choose your own dentist. Seeing out-of-network dentists will potentially be more costly because they have not agreed to accept Delta Dental’s pre-negotiated fees. You will be responsible for the difference between what your Delta Dental plan covers and what the non-participating dentist charges. If you visit an out-of-network dentist, you may need to file your own claim.
The main advantage is the cost savings to you. Our network dentists have agreed to accept lower pre-negotiated fees as payment for the services provided under your plan, which saves you money. Another advantage is that a participating dental office will file all claims for you. Also, Delta Dental will pay the dentist directly. You are only responsible for any deductible, co-insurance or co-payment at the time of your visit.
Coordination of benefits occurs when a member has dental coverage from more than one dental plan. When the claim is submitted, special criteria helps determine which dental plan is primary and which is secondary. The primary plan must pay its portion of the claim before the secondary plan pays its portion. When Delta Dental is primary, the claim is processed normally. When Delta Dental is secondary, the claim is processed, so that the combined payments provide maximum coverage without exceeding 100% of the total claim amount.
Some employer dental plans include a non-duplication clause for coordination of benefits. In this case, Delta Dental is the secondary carrier, and payment is determined by deducting the primary carrier's payment from the amount that Delta Dental would have paid if there had not been a coordination of benefits.
Some employer dental plans include a non-duplication clause for coordination of benefits. In this case, Delta Dental is the secondary carrier, and payment is determined by deducting the primary carrier's payment from the amount that Delta Dental would have paid if there had not been a coordination of benefits.
Delta Dental Premier, Delta Dental PPO or Delta Dental Premier Plus PPO refers to our dentist networks. Delta Dental of Arkansas has two networks – Delta Dental Premier and Delta Dental PPO. Your plan will determine which network is available to you. The Delta Dental Premier Plus PPO plan gives you the option to choose a dentist from either network. When a dentist participates in Delta Dental’s network, they agree to accept Delta Dental’s discounted fee as full payment for dental services. Delta Dental PPO dentists have agreed to a deeper discount for dental services, which saves you the most money.
| Delta Dental PPO | Delta Dental Premier | Non-Participating | |
| (A) Initial fee charged by your dentist | $100 | $100 | $100 |
| (B) Our contracted plan allowance | $75 | $95 | $72 |
| (C) % allowance paid under your plan | 80% | 80% | 80% |
| (D) Delta Dental pays | B x C = $60.00 | B x C = $76.00 | B x C = $57.60 |
| (F) You Pay | B– D = $15.00 | B – D = $19.00 | B – D = $42.40 |
You are welcome to file a complaint with Delta Dental of Arkansas concerning any quality of care issues you may have. Please detail your complaint in writing and mail to:
Delta Dental of Arkansas
Attn: Benefit Services
PO Box 15965
Little Rock, AR 72231
Delta Dental of Arkansas
Attn: Benefit Services
PO Box 15965
Little Rock, AR 72231
A predetermination informs you and your dentist, before the procedure is performed, if it is a covered procedure and what the reimbursement for the covered procedure will be. A predetermination, or pre-approval, is recommended for any non-emergency treatment plan of $300 or more. You will receive an estimated dollar amount of how much Delta Dental will cover for the planned procedure. A predetermination is valid 12 months from the issue date, and is subject to eligibility, benefit maximums, coordination of benefits (if applicable) and group and dentist status at the time services are provided.
For a complete list of services not covered, please visit our website to view the Schedule of Benefits. General services that are not covered include:
- Tooth implants
- Tooth whitening
- Athletic mouth guards
- Braces and retainers
- Treatment for TMJ (temporomandibular joint disturbances)
- Services to correct cosmetic dentistry
- Dental care started prior to the date the patient became covered under this plan
You can view benefit information for your dental plan when you login to the Member Portal using the login button at the top of this website. You can also call Customer Service at 1-800-462-5410.
If you are enrolled in an Individual or Family ACA plan, please mail claims to:
Delta Dental of Arkansas
PO Box 9085
Farmington Hills, MI 48333-9085
Paper claims for Delta Dental of Arkansas members should be mailed to:
Delta Dental of Arkansas
PO Box 15965
Little Rock, AR 72231
Delta Dental of Arkansas
PO Box 9085
Farmington Hills, MI 48333-9085
Paper claims for Delta Dental of Arkansas members should be mailed to:
Delta Dental of Arkansas
PO Box 15965
Little Rock, AR 72231
ACA Marketplace
Generally, the ACA mandates that all health insurance carriers include certain benefits in their health care plans. These benefits are commonly referred to as Essential Health Benefits (EHBs), and pediatric dental care is one of these benefits. When a stand-alone dental plan, such as Delta Dental, is available, federal regulators allow medical carriers not to include pediatric dental in their EHB policies, and pediatric dental benefits can be purchased from Delta Dental.
EHB benefits include the following:
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral (dental) and vision care
The specific services that must be covered under each of the 10 general categories identified above vary on a state-by-state basis.
EHB benefits include the following:
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral (dental) and vision care
The specific services that must be covered under each of the 10 general categories identified above vary on a state-by-state basis.
EHB-compliant pediatric dental benefits are provided up to age 19 in Arkansas.
Yes. Delta Dental of Arkansas will offer EHB-compliant plans for individuals and families on the individual Health Insurance Marketplace, including a dental pediatric-only option.