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<br />-- <br />-- - --- <br /> <br />7.10 <br /> <br />---- <br />--- ------ <br />------ <br /> <br />-------- <br /> <br />----- <br /> <br />If an Eligible Person has any questions about the services received from a <br />Participating Dentist, Delta recommends that he or she first discuss the <br />matter with the Dentist. If he or she continues to have concerns, the <br />Eligible Person may call or write Delta. Delta will provide notification if <br />any dental services or claims are denied, in whole or in part, stating the <br />specific reason or reasons for denial. If an Eligible Person has any question <br />or complaint regarding eligibility, the denial of dental services or claims, <br />the policies, procedures and operations of Delta, or the quality of dental <br />services performed by a Participating Dentist, he or she may call Delta to11- <br />free at (888) 335-8227 or contact Delta on the Internet - through E-Mail: <br />cms@delta.org or through the Web Site: www.deitadentalca.org. An <br />Eligible Person has 60 days after he or she receives notice to appeal a <br />denial of Benefits. If in writing, the correspondence must include the group <br />name and number, the primary enrollee's name and social security number <br />and the inquirer's telephone number. The correspondence should also <br />include a copy of the treatment form, Notice of Payment and any other <br />relevant information. He or she should clearly explain the complaint. <br /> <br />Delta will review the complaint and will respond to it within 30 days unless <br />more information or time is needed to resolve the matter. Delta may need <br />more time if the complaint is referred to a dental consultant or to a peer <br />review committee of the local dental society. If referral is necessary, a <br />reply may take longer, but in no case will it be more than 120 days after <br />Delta receives the complaint. Delta will respond, within five days of <br />receipt, to complaints involving imminent and serious threat to a patient's <br />health. <br /> <br />H an Eligible Person has completed Delta's grievance process or has <br />been involved in Delta's grievance process for 60 days, he or she may <br />me a complaint with the Department of Corporations. A complaint <br />may be med with the Department immediately in an emergency <br />situation which involves imminent and serious threat to the Eligible <br />Person's health. <br /> <br />22 <br /> <br />un____- <br />