Submit a Grievance

You can complete an online grievance form below, or email, fax or mail a grievance form to us.

NOTE: If you choose to submit your grievance online, please be advised that communications submitted through the Internet are not considered secure. Although it is unlikely, there is a possibility that information you include in electronic communications (online and email) can be intercepted and read by other parties besides the person to whom it is addressed. You always have the option of submitting a grievance by mail or fax. Please do not include any sensitive protected health information, such as your Social Security number or birth date in electronic communications you send to us.

Note the above disclaimer and complete our Grievance Form PDF and email it to 

You may also fax a completed Grievance Form PDF to 630-300-5547 or mail it to Delta Dental of Illinois, 111 Shuman Blvd, Naperville, IL 60563, Attention: Grievance Committee

If you have any questions, please contact us at 800-323-1743.

All fields marked with * are required.

Delta Dental of Illinois Member Grievance Form

Member/Patient Information

Information on Issue to be Addressed