Delta Dental of Missouri Toggle Mobile Menu HomePrivacyHipaaDelta Dental of Missouri - PrivacyHIPAA - Privacy/HIPAA Privacy/HIPAA Privacy Notice Download our privacy notice. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. This notice is effective as of November 1, 2018. General Terms and Conditions Dentist's Terms and Conditions Subscriber Terms and Conditions Groups Terms and Conditions By accessing and/or utilizing the information on this website, you acknowledge and agree to the terms and conditions above. Website Cookie Information To learn more about how this site uses cookies, please refer to the terms and conditions documents above. To learn how to delete browser cookies, please click here. Authorization Download our authorization form. An authorization is a written document, signed by the patient/subscriber or his/her personal representative, that specifically allows Delta Dental of Missouri to disclose PHI with permission. Delta Dental must obtain express authorization for disclosure of PHI that is not for TPO (Treatment, Payment and Operations) or not otherwise authorized by HIPAA. The authorization must be in writing, and the form must contain specific requirements mandated by HIPAA. Delta Dental may not condition treatment upon authorization. Completed authorization forms can be faxed to 314-656-2900 or mailed to Delta Dental of Missouri; 12399 Gravois Road; St. Louis, MO 63127. The authorization is revocable at will at any time. Sign up for dental tips Delta Dental of Missouri 12399 Gravois Road St. Louis, Missouri 63127-1702 Privacy / HIPAA Terms & Conditions Careers Oral Risk Assessment Download Our Mobile App Delta Dental of Missouri is a part of the Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories. Copyright © 2021 Delta Dental of Missouri Accept cookies & privacy policy? This website uses cookies to collect data in order to improve user experience. By continuing to use this site you agree to the use of cookies. For more information, please click here. ContinueCustomize Cookies