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Dental Benefit

How To File A Claim

Dental Blue POS dentists will send claims to Blue Cross and Blue Shield for you. Just show them your Dental Blue POS ID card. We'll send the payment directly to your dentist. If you receive emergency care in Massachusetts by a nonparticipating dentist, you or the dentist may file an Attending Dentist's Statement.

If you receive care from an out–of–network provider, you must submit the claim yourself.

• Send the Attending Dentist’s Statement with the original itemized bills.
• We will send any benefit payment to you.
• You can get Attending Dentist’s Statements from Customer Service or your plan sponser.

Send all claims to:

Blue Cross and Blue Shield of Massachusetts
Landmark Center 01-08
401 Park Drive
Boston, MA 02215-3326

Please note: All claims must be submitted within two years of the date of service.

Your Right to a Claim Review
If you have a question about the payment or denial of your claim, you should complete the following steps:

Step One - If you disagree with our decision about your claim or coverage, or if you have a complaint about the care or service you received from us or any health care provider, you have the right to a review. You begin by contacting Customer Service. Please always keep a record of whom you contact and when.

Step Two - If you disagree with the decision given to you by Customer Service, you may write to our Appeals Program. To help speed up the process, please provide as much information as possible, including:

• Member's name and ID number
• Description of the problem, including any relevant dates
• Names of health care providers or others involved
• Details of your attempt(s) to resolve the case

Appeals Program
Blue Cross and Blue Shield of Massachusetts
Landmark Center 01-08
401 Park Drive
Boston, MA 02215-3326

We will investigate the problem and reply within 30 days. We'll do our best to resolve your appeal more quickly for services you are either receiving now or planning to receive.

Step Three - If you disagree with the Appeals Program, you have the right to attend a hearing to present your appeal. We'll work with you to schedule this hearing and will notify you of the decision within five business days of your hearing.

Other Information
Coordination of benefits, or COB, applies to plan members who are covered by another plan for health care expenses. COB ensures that payments from all health care plans do not exceed the total charges billed for covered services.

Your subscriber certificate has a subrogation clause. This does not affect the scope of benefits. It allows us to retract claim payments when a member recovers payment for the same charges from a third party due to liability for injury.

Limitations and Exclusions
Your Dental Blue POS Subscriber Certificate and riders chosen by your group, and Orthodontic Endorsement contain a complete list of exclusions and limitations.

Dental Blue POS does not provide benefits for:

• A service or procedure that is not generally accepted, as determined by Blue Cross and Blue Shield
• Services that are rendered due to the requirements of a third party, Such as an employer or school
• An illness or Injury that we determine arose out of and in the course of your employment
• An illness or injury for which any benefits are available through a government program (local, state, national, or foreign) which provides or pays for health services, not including Medicaid or Medicare
• A method of treatment more costly than is customarily provided. Benefits will be based on the least costly method of treatment

• A service to treat disorders of the joints of the jaw (temporomandibular joints)
• Services that are meant primarily to change or improve your appearance
• Replacement of dentures, bridges, space maintainers, or periodontic appliances due to theft, misplacement, or loss
• Duplicate dentures and bridges
• Lab tests
• Occlusal guards

Call: 1–800–217–7878 or Write:

Blue Cross and Blue Shield of Massachusetts
Landmark Center 01-08
401 Park Drive
Boston, MA 02215-3326