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FAQ
Do I have to
choose a dentist?
No. You may select the dentist of your choice. However,
you will receive the highest level of benefits available
in your group’s program by choosing an in-network
provider. When you visit a participating dentist, you
have the opportunity to maximize your benefit plan with
access to negotiated network fees, resulting in lower
out-of pocket expenses.
What is a
negotiated network fee?
A negotiated network fee refers to a discounted schedule
that participating in-network providers agree to accept
as payment in full for services rendered. Typical
discounts range from approximately 20%-35%. Depending on
the service rendered, your plan may cover all or part of
the discounted fee.
How many
dentists are in-network?
There are over 82,000 participating in-network dentists
nationwide, including over 19,000 specialists. So, you
should have no problem finding a participating provider
in your area, while traveling, if emergency care is
needed, or for your eligible dependents away at college.
All in-network dentists meet strict credentialing
standards and have agreed to accept negotiated discounts
as payment-in-full (no balance billing) for covered
services rendered.
How do I
locate in-network dentists?
You can conduct online provider searches on our website
at www.denexdental.com, or call our Customer Service
Department at 1-866-4Denex1.
The dentist I want to visit does not participate
in-network. Is there anything I can do to encourage my
dentist to participate?
Yes. Our dental network is continually expanding and new
providers may be added, if they meet our credentialing
standards. Either you or your dentist can fill out a
“nominate a provider form” available on the Denex Dental
website at www.denexdental.com. Please note, that there
may be instances where the dentist chooses not to
participate in our network, or we choose not to accept
the application due to our stringent credentialing
process.
Do my Dependents have to visit the same dentist that I
visit?
No, you and your dependents have the freedom to choose
any dentist, and can switch as many times as you would
like during the policy year.
How do I get reimbursed if I visit a dentist
out-of-network?
If you visit a dentist out-of-network, you may be
responsible for paying the entire fee at the time of
service. You must then submit a claim form to Denex
Dental.
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How and when do
I file a claim?
In-network providers have contractually agreed to file
claims for you. If your dentist does not participate in
the network (out-of-network), you may have to file the
claim yourself. A claim form is included in your welcome
kit; it is also available from your benefits
administrator, or it can be printed from the Denex
Dental website at: www.denexdental.com. Remember to
bring a claim form with you to your appointment so your
dentist can help you fill it out. For each claim
submission, Denex Dental will mail you, within
approximately 5-7 business days of receipt, a concise
explanation of benefits and reimbursement according to
your plan guidelines. For questions regarding claims or
benefits, please call:
1-866-4Denex1.
Denex Dental Claims Address:
P.O. Box 10949
Rockville, MD 20849
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Can I find out how much services will cost me
out-of-pocket and obtain an estimate of what will be
covered prior to treatment?
Yes, Denex Dental strongly suggests that you have your dentist
submit a request for a pre-authorization for services in
excess of $300. This often applies to major services
such as crowns, bridges, dentures, periodontics and oral
surgery, and is required for Periodontal Scaling and
Root Planning, a costly procedure that is not necessary
for everyone. If your provider recommends this course of
treatment, have him or her submit, a pre-authorization
form, along with the necessary periodontal charting, and
necessary records for Denex Dental to approve.
Denex Dental will review all requests to ensure a high
standard of care, and determine whether the member or
eligible dependent does, in fact, require the procedure.
A detailed estimate of what services are covered, and at
what payment level, will be sent to both you and your
dentist within 48 hours of receipt. If the service is
denied, you will be responsible for payment in full.
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What happens after I fill out my enrollment form? How do
I know I can start using my coverage?
Upon receipt of your group’s enrollment materials, you
will be issued a group number and will be eligible for
coverage. We will also send individual welcome packets,
including all contact and service information, and
customized ID cards to your group’s benefits
administrator.
Do I need
an ID to receive services?
No, you do not need to present your ID card to your
dentist to receive treatment. Notify your dentist that
you are enrolled in Denex Dental, and that you are using
the Dentemax network. Your dentist can easily call the
Denex Dental Customer Service Department to verify
eligibility.
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