If separate dental benefits are available to the employee, spouse or dependent under other programs, there are specific conditions applicable to determination of payment. The ratio of each carrier s liability to total cost incurred is reviewed. Payment is made according to the birthday rule adopted by most insurance carriers. In no case does Delta pay in excess of its total contractual obligation if it were the only carrier involved. If the other carrier determines its benefits first, Delta will pay any difference between the amount paid by the other carrier and the charge for the covered service, to the extent of Delta s benefit for the given procedure.
Delta attempts to process all claims within a reasonable processing time.
If a claim will be delayed more than 30 days, Delta will notify the subscriber, in writing, of the reason for the delay. Any dissatisfaction with adjustments made or denials of payment should be brought to the attention of the Vice President, Claims Administration of Delta. That office of Delta will advise you of your rights of appeal or other recourse. Orthodontic benefits may be prorated for treatment begun before the patient is eligible. Dental benefits may be based on the least costly treatment that conforms to generally accepted dental practice.