Guidelines for Out-of-Country Claims Submission
As a Delta Dental subscriber, you can visit any licensed dentist anywhere in the world for your dental care.
Even if you're out of the country when you receive dental treatment, you have peace of mind when you have Delta Dental coverage.
In order to process an out-of-country claim for dental services including diagnostic &
preventive, restorative, and major, please follow these instructions carefully.
The patient section of the insurance form must include:
- Patient Name
- Subscriber ID or SSN
- Patient date of birth
- Information on other coverage
The dentist section of the insurance form must include:
- Dentist Name
- Dentist address
- Dentist telephone number
- Dentist's license number
The insurance claim form or the itemized statement must include:
- Tooth number where applicable
- Description of the service
- Date of service
- Procedure code
- Each procedure must be listed and priced separately; we cannot calculate benefits when services and fees
are combined (plesae specify currency).
You are responsible for payment to the dentist at the time of service. The reimbursement check will be sent to your address.
