Delaware Administrative Code
Title 1 - Authorities, Boards and Commissions
300 - Victim's Compensation Assistance Program Advisory Council
301 - Victims' Compensation Assistance Program Rules and Regulations
Section 301-30.0 - Payment of Dental Claims
Current through Register Vol. 28, No. 3, September 1, 2024
30.1 Expenses for dental services [including periodontal and orthodontic care and oral surgery] shall be paid on behalf of the victim to a licensed dental practitioner at a rate and in an amount set by VCAP. If VCAP accepts a claim, the dental practitioner shall accept the VCAP payment as payment in full, and may not attempt to collect from the victim or third parties any amount exceeding the amount of reimbursement made by VCAP. VCAP payments shall be accompanied by a notice that provider acceptance constitutes acknowledgement of payment in full.
30.2 VCAP will pay a dental provider at the rate of 80% of the usual and customary charge for such services. When a third party has made payment, and the victim is responsible for a co-payment, VCAP may reimburse for amount of the co-payment. VCAP may pay a lesser amount, if payment under this section would exceed a statutory or regulatory cap.
30.3 If the usual and customary charge cannot readily be established, or in special circumstances, VCAP may, in its discretion, determine the reasonable charge for the procedure performed or the service rendered.
