- Do I have to submit claim forms? And where do I send them?
- Do I have to get pre-approval for certain procedures?
- What is the most common cause for claims delay?
- What about services that are not covered by my dental plan?
A dental claim form should be used to file a claim when dental services are rendered. The claim form is completed by the dentist and mailed to the Benefit Center address listed on the back of the Dental ID card. You can also obtain the correct mailing address by calling Customer Service at 800.442.7742. In cases where the dentist does not file the claim for you, print this dental claim form, complete it fully, attach the bill and submit it to the address listed on your Dental ID card.
We highly recommend that if the charge for any treatment is expected to exceed $300.00 that a dental treatment plan be submitted to us for review before treatment begins. In estimating the amount of benefits payable, we will consider whether or not an alternate treatment may accomplish a professionally satisfactory result. The pre-estimate is not an agreement for payment of the dental expenses. The pre-estimate process lets you know in advance approximately what portion of the expense we will consider covered dental expenses. An estimate of the benefits payable will be sent to you and your dentist and this will help you to plan for your remaining cost, if any, for the service
Occasionally, we must request x-rays, periodontal charting and/or other claim related information to complete the processing of a claim if it is not initially submitted with the claim. If it is necessary to request additional information on a claim, the Dental Benefit Analyst will request this information from the dentist and they will also notify you of the request.
Non-covered services are your responsibility. However, our PPO network dentists have agreed to discount non-covered services, as well as covered services. Our PPO network dentists cannot balance bill the remaining cost between their usual and customary fee and the negotiated rate with us.