Delta Dental of New Mexico

Home / Members / Out of Country Claims

Couple

Out of Country Claims

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.

When you see a dentist outside of the U.S., you are responsible for obtaining the necessary documentation for services provided, filing a claim with Delta Dental, and paying the dentist at the time services are performed. When you submit your claim and accompanying documentation, please include a valid phone number or email address so that we may contact you if necessary to prevent delays in processing your claim.

Submitting your Claim Form

In order to submit an out-of-country claim for dental services including diagnostic and preventive, restorative, and major, please follow these instructions carefully:

  • Complete items #1-23 of the patient section of the claim form, and sign item 36.
  • Have the dentist complete items #24-58 (excluding #37) of the dentist section of the claim form. This section must be filled out according to the current version of the American Dental Association's CDT Code.
  • Ensure the claim form or the itemized statement includes the following information:
    • Procedure Date
    • Area of Oral Cavity
    • Tooth System
    • Tooth Number(s) or Letter(s)
    • Tooth Surface
    • Procedure Code
    • Description
    • Fee
  • Ensure you meet the other requirements listed in the section below, "Other Requirements and Information."
  • Submit your claim form and other required documents to:
Delta Dental of New Mexico
2500 Louisiana Blvd. NE, STE. 600
Albuquerque, NM  87110

 

Other Requirements and Information

Please include these additional documents, if applicable, with your claim form.

  • For out-of-country claims, Delta Dental requires an itemized receipt indicating the country’s currency.
    • Delta Dental will calculate foreign currency benefit payments based on published currency conversion tables that correspond to the date of service.
  • For Mexican claims, the receipt must be numbered, include a tax stamp as mandated by Mexican legislation, and show the paid amount in pesos (not U.S. dollars). Compliance is required by Mexico’s Tax Authorities.
  • Below is a list of procedure information that is required to process your claim. Please request this vital information from your dentist prior to treatment or before completion of your treatment:

    • Prior to any major treatment being started, the dentist must take a radiographic image of the treatment area. Please submit a copy of the image with your claim.
    • If the claim is for a crown, bridge or partial, your dentist needs to indicate if this is an initial placement.
    • If it is not an initial placement, your dentist needs to provide the date of prior placement. Please submit this information with the claim form (item #44).
  • You are responsible for payments to the dentist at the time of service. The reimbursement check will be sent to your address on file. Delta Dental does not allow assignment of benefits for out-of-country claims.

Plan Ahead with a Pre-Treatment Estimate

If you are planning an extended out-of-country stay and you require major services, if possible, we strongly urge you to request a pre-treatment estimate. Learn more about pre-treatment estimates here.