All dental claims must be filed within two years from the date services were received. Before filing a dental claim, consider whether the expense may be covered under your medical plan. Be sure to read the information in the Medical claims for dental work section above.
Aetna Dental PPO Network providers should file all claims directly with Aetna.
Claims for non-network provider care
The Plan has contracted with Aetna to process claims (see Information sources at the front of this SPD for the address and telephone number).
Before visiting a dentist who is not in the Aetna Dental PPO network, obtain a claim form from Aetna, Employee Connect, or ExxonMobil Family websites for yourself and/or each eligible family member having work done. Fill out the form with personal data about yourself or your family member. Give the form to the dentist. In many cases, the dentist will file the claim for you. If the dentist returns the form to you, send it and the dentist's itemized bill to Aetna. Keep a copy of the completed form for your records.
Keep these facts in mind when using a non-network provider:
- Most dentists expect payment in full for services at the time the work is done.
- When you file a claim form, benefits will be sent to you unless you specifically indicate that Aetna should pay the dentist directly.
In order to be reimbursed under the Plan, claims must be received by Aetna within two years from the date the expense was incurred. It is the participant's responsibility to ensure that claims are filed in a timely manner. If you or your dental provider submits claims past the claim filing deadline, those claims will not be covered by the Plan. You will be responsible for payment.
Explanation of benefits
Aetna will send you an explanation of benefits (EOB) for each claim. The EOB will show what service was performed, how much the dentist charged, and what the covered charge is under the Plan. It shows if a deductible or coinsurance was involved as well as the calculation used to determine your benefit. If payment is not assigned to the provider the EOB for the claim will only be sent to the participant; requests for any additional information needed to resolve the claim will go to participant only.
Claim denial and reconsideration
If all or part of a claim is denied, Aetna will provide you with a written explanation, including the reason for the denial. See the Administrative and ERISA information section in this SPD.
Claims outside the United States
To receive dental care when traveling or working outside the United States, generally you must pay the dental bills first. For reimbursement, submit a claim form and an itemized bill that includes a copy of the tooth chart clearly identifying the tooth number(s) and copies of the diagnostic dental x-rays, periodontal charting, and narrative as appropriate. Indicate if the provider is using a USA standard tooth number or a different tooth identification standard. If the original bills are in a foreign language, you should obtain an English translation, if possible, of the services rendered.
Bills should be submitted in the appropriate foreign currency. The claims administrator (Aetna) will convert the bill to U.S. dollars as of the date of service using the currency converter website Oanda at www.oanda.com.