Filing A Claim
When the Dentist Files a Claim
Your dentist will file a claim for you when you receive a covered dental service from a dentist who has a written payment agreement to furnish covered dental services to members enrolled in a Dental Blue PPO plan or a Dental Blue plan. Just tell the dentist that you are a member and show the dentist your Dental Blue Freedom identification card. Also, be sure to give the dentist any other information that is needed to file your claim. You must properly inform your dentist within 30 days after you receive the covered dental service. If you do not, benefits will not have to be provided. The dentist will be paid directly for covered dental services.
When the Member Files a Claim
You may have to file your claim when you receive a covered dental service from a dentist who does not have a written payment agreement to furnish covered dentist services. The dentist may ask you to pay the entire charge at the time of the visit or at a later time. It is up to you to pay your dentist. To file a claim for repayment, you must: fill out a claim form; attach your original itemized bills; and mail the claim to the Blue Cross and Blue Shield customer service office. You can get claim forms from the Blue Cross and Blue Shield customer service office. You must file a claim within two years of the date you received the covered dental service. Dental Blue Freedom will not have to provide benefits for services for which a claim is submitted after this two-year period.
Timeliness of Claim Payments
Within 30 calendar days after Blue Cross and Blue Shield receives a completed request for benefits orpayment, a decision will be made and, where appropriate, payment will be made to the dentist (or to you if you sent in the claim) for your claim to the extent of your benefits described in this Dental Blue Freedom Benefit Description. Or, you and/or the dentist will be sent a notice in writing of why your claim is not being paid in full or in part. If the request for benefits or payment is not complete or if more information is needed to make a final determination for the claim, Blue Cross and Blue Shield will ask for the information or records it needs within 30 calendar days of receiving the request for benefits or payment. This additional information must be provided to Blue Cross and Blue Shield within 45 calendar days of this request. If the additional information is provided to Blue Cross and Blue Shield within 45 calendar days of the request, a decision will be made within the time remaining in the original 30-day claim determination period or within 15 calendar days of the date the additional information is received, whichever is later. If the additional information is not provided to Blue Cross and Blue Shield within 45 calendar days of the request, the claim for benefits or payment will be denied. If the additional information is submitted after this 45 days, then it may be viewed as a new claim for benefits or payment. In this case, a decision will be made within 30 days as described previously in this section.