Delta Dental

Have You Been Denied Coverage For A Dental Procedure By Delta Dental Of California/Dentagra?

Delta Dental Of California, also known as Dentagra, provides dental insurance for millions of Californians - dental insurance that Californians buy believing they can count on it when it matters. For many consumers, however, this has not been the case.

A Kazerouni Law Group, APC, investigation has uncovered reports that Delta Dental/Dentagra has systematically and wrongfully denied claims from Californians that should have been covered under their paid-for plan.

Kazerouni Law Group, APC, is one of the largest consumer right law firms in California, and one of the best at fighting insurance companies who deny coverage they owe to Californians like you. You won't pay a dime until we win or settle your case. Contact us below for a free case evaluation.

You May Be Eligible For Compensation!

If you have been denied coverage for a dental procedure by Delta Dental/Dentagra, contact us immediately for a free consultation. You may be eligible for compensation, including repayment of dental bills and damages.

Kazerouni Law Group, APC, is one of the leading consumer rights law firms in California, and has the experience needed to fight against large insurance companies- and win. You would pay nothing until we win or settle your case. To begin your free consultation, fill out the form to the right or call us at 1-800-778-2065

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Denied by Delta Dental? Here’s How a Lawyer Can Help You Fight Back

When a dental insurance company like Delta Dental denies your claim, it feels unfair and frustrating. You paid your premiums, followed the rules, and expected coverage for your dental procedures.

Now you're left with unexpected bills, unanswered questions, and a feeling of being stuck. But you don’t have to face this alone.

A lawyer experienced in handling dental benefits plan denials can help you challenge Delta Dental’s decision and work toward a fair outcome.

Common Reasons Delta Dental Denies Claims

Insurance companies like Delta Dental deny claims for a variety of reasons, some of which may seem arbitrary. Knowing why your claim was denied is the first step toward fighting back.

Common denial reasons include:

  • Claim errors: Mistakes in codes, billing, or documentation by the dental office
  • Coverage disputes: Delta Dental argues that the procedure isn’t covered by your policy
  • Out-of-network issues: Claims are denied because the dentist wasn’t in Delta Dental’s network of dentists nationwide
  • Medical necessity: Delta Dental may argue that the dental procedure wasn’t "necessary"
  • Timely filing limits: Delays in filing claims can result in automatic denials

Insurance companies may use these reasons to avoid paying claims, but a lawyer can push back and challenge the legitimacy of their denials.

Signs You Need a Lawyer for Your Denied Claim

Not every denied claim requires a lawyer, but certain red flags signal it’s time to seek legal help.

When to call a lawyer:

  • Delta Dental refuses to communicate or delays your appeal
  • Your dental patient direct coverage is being misapplied
  • Your claim was denied because of alleged issues with "medical necessity"
  • You’re dealing with a large bill for major dental procedures
  • You’re unsure how to dispute Delta Dental’s decision or feel overwhelmed

If any of these apply, speaking with a lawyer early in the process gives you the best chance of reversing the denial.

Your Rights Under the Law

If Delta Dental denied your claim and left you covering the cost of necessary dental procedures, you have legal options to recover those expenses. Paying for dental care that should have been covered by your dental benefits plan isn't just frustrating — it’s financially draining.

But you don’t have to accept their decision as final. With the right legal support, you can pursue compensation for the care you paid for out-of-pocket.

One of the strongest legal protections comes from the Employee Retirement Income Security Act (ERISA), which governs many employer-sponsored dental insurance plans.

If your dental coverage is provided through your company's human resources department, ERISA provides specific rights to challenge wrongful denials. If your plan isn’t employer-sponsored, you may still have a right to sue under consumer protection laws.

Key rights you may have include:

  • The right to reimbursement: If you paid for dental care covered by your dental benefits plan but were denied, you may be able to recover those costs. This includes routine care, major dental procedures, and treatments that support your oral health and wellness.
  • The right to sue for unpaid claims: If your appeal is denied, you have the right to file a lawsuit to recover expenses for dental treatments that should have been covered.
  • The right to demand transparency: Delta Dental is required to provide clear, written explanations for why claims were denied. Their decision must be based on specific policy language, not vague reasoning.
  • The right to appeal denials: If your claim was wrongfully denied, you have the right to submit an appeal. Appeals force the insurance company to review its decision and reconsider its denial.
  • The right to hold Delta Dental accountable: If Delta Dental misrepresented policy details, delayed payments, or used bad faith tactics to avoid paying your claim, you may have grounds to seek additional damages.

These rights protect you from having to pay for care that should have been covered under your dental insurance plan. A lawyer familiar with Delta Dental of California and other Delta Dental companies can help you demand the compensation you're owed.

How Long Do You Have to Appeal a Denied Delta Dental Claim?

Time is critical when dealing with a denial from Delta Dental. Each dental insurance company has its own deadlines for appeals, and employer-sponsored plans are often governed by ERISA, which imposes specific timelines for filing appeals.

Important timeframes to know:

  • Delta Dental requires appeals to be filed within a set period (check your policy for details)
  • ERISA-regulated plans generally give you 180 days to file an appeal
  • Missing deadlines means you may lose your right to challenge the denial

A lawyer can ensure you don’t miss key deadlines and submit the right documentation to protect your claim.

Protect Your Oral Health and Financial Well-Being

When your claim is denied, it’s not just your finances that suffer — it’s also your oral health. Dental care is a critical part of your overall wellness, and skipping necessary procedures due to unpaid claims affects your long-term health.

Don’t let Delta Dental’s denial prevent you from accessing care like:

  • Crowns, fillings, and major dental procedures
  • Preventative treatments recommended in health and wellness reports
  • Procedures for children that inspire lifelong healthy habits

A denied claim isn’t just about one procedure — it’s about maintaining your overall health. A lawyer can help you fight for the benefits you deserve so you don’t have to sacrifice your wellness.

Take Action Today — Get Help With Your Denied Claim

If Delta Dental denied your claim, you’re not alone. Thousands of policyholders face denials every year, but you have options. Working with a lawyer can make all the difference, from filing appeals to taking legal action if necessary.

Here’s what you can do today:

  • Document your case: Collect your policy, dental procedure records, and all communications from Delta Dental.
  • Call a lawyer: Get advice on how to challenge the denial and protect your financial well-being.
  • Act quickly: Time is limited to appeal, and delays could cost you your chance to dispute the claim.

Don’t let Delta Dental's decision stand without a fight. Legal support is just a call away.