Filing a Claim. Whether the Subscriber, dependent, or beneficiary is treated by a dentist who is a Delta Dental participating dentist, or is not a Delta Dental participating dentist, the filing forms and procedures shall be the same, as defined in the DDPOK Claim and Appeal Procedure manual, which will be provided upon request, without charge, as a separate document. Once treatment is completed, the Subscriber, dependent, beneficiary, or designated personnel in a dental office must complete the information portion of the claim form with the Subscriber’s full name, Subscriber’s social security number, the name and date of birth of the person receiving dental care, and the group name and number. All claims must be submitted to Delta Dental Plan of Oklahoma at the assigned address. DDPOK is not obligated to pay any claim submitted later than twelve (12) months following the date of service. Participants and beneficiaries can obtain, without charge, the necessary claim filing forms from DDPOK.
Appears in 4 contracts
Samples: Dental Insurance Agreement, Dental Insurance Agreement, Plan Agreement
