Member Services

Aetna Dental: How to file a claim

Claims should be filed promptly. Use a claim form and follow the instructions on the form. Claims should be made within 90 days after obtaining the service or as soon thereafter as reasonably possible. Failure to file on a timely basis may invalidate your claim because the Dental Plans will not pay benefits for claims submitted more than two years from the date the expense is incurred (except where the member is legally incapable).

Under the DMO^® Plan, you will not have to submit a claim form. In the event of an emergency, call the toll-free DMO^® Member Hotline (800-843-3661) to obtain instructions for filing your claim.

Under the Alternate Dental Plan, follow the steps below:

1. Before you or a covered dependent goes to the dentist, obtain a claim form. Complete the section "To be completed by insured" and take the form to the dentist on the first visit. (If emergency treatment is required and you cannot get a claim form in advance obtain the form and give it to the dentist as soon as you can.)

2. If the estimated fee is more than $300:
   1. Your dentist will determine what treatment should be given and will show that on the claim form. The dentist will send the form to Aetna.
   2. Aetna will return the form to the dentist showing a predetermination of the benefit and your portion of the fee.
   3. At this point you will have the opportunity to review the predetermination of benefits with the dentist and to decide whether any changes should be made in the treatment plan.
   4. Your dentist will proceed with the agreed-upon treatment and will submit the claim to Aetna when the work is completed.

3. If the estimated fee is $300 or less or is for emergency treatment:
   1. The dentist will proceed with the treatment without first sending the form to Aetna.
   2. When the work is completed, the dentist will send the form to Aetna.

To obtain an Alternate Dental Plan claim form, you may contact Aetna, print the forms from the SAMBA website or call SAMBA at:

(800) 638-6589 or (301) 984-1440

Send The Alternate Dental Plan claims to:

Aetna Dental Group Dental Claim Division P.O. Box 14094 Lexington, KY 40512-4094 (800) 445-2283