Other Carriers’ Appeals Process
Was your claim denied? You have the right to appeal the carriers below. (Looking to appeal an eligibility or enrollment decision? Find more information here»)
Group Health members:
Submit a Group Health-related claim appeal here.
Kaiser Permanente members:
Submit a Kaiser Permanente-related claim appeal here.
Delta Dental Appeals Process:
If your claim for dental benefits has been completely or partially denied, you have the right to request an informal review of the decision.
Either you, or your authorized representative (see below), must submit your request for a review within 180 days from the date your claim was denied (please see your explanation of benefits form).
A request for a review may be made orally or in writing, and must include the following information:
- Your name and ID number
- The group name and number
- The claim number (from your explanation of benefits form)
- The name of the dentist
- You may include any written comments, documents or other information that you believe supports your claim
Submit Your Appeals
Please submit your request for a review to:
Washington Dental Service
Attn: Appeals Coordinator
P.O. Box 75983
Seattle, WA 98175-0983
For oral appeals, please refer to the phone numbers listed on the inside front cover of your benefit booklet. 2012-08-00018-BB-04 Individual Providers – Plan A 20.
WDS will review your claim and make a determination within 30 days of receiving your request and send you a written notification of the review decision.
Upon request, you will be granted access to and copies of all relevant information used in making the review decision.
Informal reviews of wholly or partially denied claims are conducted by persons not involved in the initial claim determination.
In the event the review decision is based in whole or in part on a dental clinical judgment as to whether a particular treatment, drug or other service is experimental or investigational in nature, WDS will consult with a dental professional advisor.