Appeals

Appeals Delta Dental of Missouri (DDMO) has established a first-level and second-level review process for written complaints. A first-level review, whether related to an adverse benefit determination or for reasons other than an adverse benefit determination, must be submitted in writing to DDMO's Customer Service Department. You have 180 days to submit your written complaint after receiving the denial or the notice that gave rise to the complaint. DDMO shall allow 180 days from the date allowed to file the first level complaint or 180 days from the date DDMO sent notification to the person who submitted the complaint of DDMO's resolution of said first level complaint, whichever is later. Any complaint should be accompanied by documents or records in support of the complaint. You may review pertinent documents relating to the claim and submit issues and comments in writing for consideration.

DDMO will acknowledge receipt in writing within 10 working days and will investigate the complaint within 20 working days after receipt of a complaint. If additional time is needed to complete the investigation, DDMO will notify you in writing on or before the 20th working day with the investigation completed within 30 working days thereafter. DDMO will notify you in writing of the decision within five working days following the investigation. You have the right to request a second-level review, in which case DDMO shall follow the same time frames as a first-level review, except in the case of a request for an expedited review where life or health of an enrollee may be in jeopardy.

Any first-level complaint should be sent to:
Delta Dental of Missouri
Customer Service Department
12399 Gravois Road
St. Louis, MO 63127-1702

Second-level appeals should be sent to:
Delta Dental of Missouri
Appeals Committee
12399 Gravois Road
St. Louis, MO 63127-1702

You have the right to file an appeal with the Director of the Missouri Department of Insurance at any time.

For detailed information on filing an appeal with the Missouri Department of Insurance, (MDI), contact:
Missouri Department of Insurance
Financial Institutions & Professional Registration
Attn: Consumer Affairs
PO Box 690
Jefferson City, MO 65102

Or call 800-726-7390.