In An Emergency
When you experience tooth pain or a tooth injury, it's important to seek dental care as soon as possible. Make sure you have your dentist's name and phone number with you as dental emergencies can happen at any time.
Delta Dental PPO℠ and Delta Dental Premier® network dentists have waiting periods of no longer than 24 hours for emergencies. Delta Dental PPO Plus Premier plan members are free to visit any licensed dentist, but will save the most using a network dentist. Members using an ACA certified plan and wanting the ACA certified benefit must use a Delta Dental PPO dentist.
Patient Direct members must use a Patient Direct dentist to receive the applicable fee schedule.
DeltaCare members must select a primary dentist who refers them to a specialist. In the case of an emergency, the DeltaCare procedures are below.
DeltaCare Emergency Procedures
Triage and/or palliative care, if needed, must be available 24/7 for - severe dental/oral pain, bleeding or swelling; or dental emergencies that risk life or disability without timely professional care.
If you are more than 35 miles from your primary dentist or are unable to see your primary dentist within 24 hours AND you require emergency treatment, you may go to any dentist and will be reimbursed for the treatment cost, less any applicable co-payment amount, up to a maximum of $50 once during any 12-month period. Please note that emergency treatment and reimbursement for that treatment is intended for the relief of severe dental/oral pain or to treat dental emergencies that risk life or disability without professional care. Follow-up care for treatment completion should be performed by your primary DeltaCare DHMO dentist.
If you are in this situation, you must contact customer service within 24 hours of treatment for authorization. You must also submit the dentist's statement and proof of payment for emergency services within 90 days after receiving treatment.
If a DeltaCare dentist is not available in the timeframes designated, please contact Delta Dental of Illinois Customer Service at 800-942-3772 and we will immediately investigate the specific reason for the unavailability.