HOW TO FILE A CLAIM. Network dentists file claims on your behalf. Non-network dentists may or may not file claims on your behalf. If a non-network dentist does not file a claim on your behalf, you will need to file it yourself. To file a claim, please send us the dentist’s itemized bill, and include the following information: • your name; • your member ID number; • the name, address, and telephone number of the dentist who performed the service; • date and description of the service; and • charge for that service. Please send your claim to the address listed in the Contact Information section. Claims must be filed within one calendar year of the date you receive a covered dental service. Claims submitted after this deadline are not eligible for reimbursement. This timeframe does not apply if you are legally incapacitated.
Appears in 10 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
HOW TO FILE A CLAIM. Network dentists file claims on your behalf. Non-network dentists may or may not file claims on your behalf. If a non-network dentist does not file a claim on your behalf, you will need to file it yourself. To file a claim, please send us the dentist’s itemized billxxxx, and include the following information: • your name; • your member ID number; • the name, address, and telephone number of the dentist who performed the service; • date and description of the service; and • charge for that service. Please send your claim to the address listed in the Contact Information section. Claims must be filed within one calendar year of the date you receive a covered dental service. Claims submitted after this deadline are not eligible for reimbursement. This timeframe does not apply if you are legally incapacitated.
Appears in 5 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
HOW TO FILE A CLAIM. Network dentists file claims on your behalf. Non-network dentists may or may not file claims on your behalf. If a non-network dentist does not file a claim on your behalf, you will need to file it yourself. To file a claim, please send us the dentist’s itemized billxxxx, and include the following information: • your name; • your member ID number; • the name, address, and telephone number of the dentist who performed the service; • date and description of the service; and • charge for that service. Please send your claim to the address listed in the Contact Information section. Claims must be filed within one calendar year of the date you receive a covered dental service. Claims submitted after this deadline are not eligible for reimbursement. This timeframe does not apply if you are legally incapacitated.
Appears in 2 contracts
Samples: Subscriber Agreement, Subscriber Agreement
