These are generally the subscriber s share of UCR co-payments, deductibles, charges where maximums have been exceeded, or there are charges for services not covered by the Group Dental Service Contract. Payment for services performed for a subscriber by a non-participating dentist is also calculated by Delta on a UCR basis, but Delta pays its share to the subscriber. The subscriber is responsible for payment of the Non-participating dentist s total fee, which may include amounts in addition to the subscriber s share of Delta s calculation of UCR and services not covered by the Group Dental Service Contract. 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.