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 Frequently ask Questions

Find answers to the most commonly asked questions about Denex Dental Insurance Coverage. If you do not find the answers you're looking for, please contact us for further assistance.

  Do I have to choose a dentist?
  What is a negotiated network fee?
  How many dentists are in-network?
  How do I locate in-network dentists?
  The dentist I want to visit does not participate in-network. Is there anything I can do to encourage my dentist to participate?
  Do my dependents have to visit the same dentist that I visit?
  How do I get reimbursed if I visit an out-of-network dentist?
  How and when do I file a claim?
  Where should I mail my claim?
  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?
  What happens after I fill out my enrollment form? How do I know I can start using my coverage?
  Do I need an ID card to receive services?

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 170,000 participating providers nationwide. 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 an online provider search by clicking here, or call our customer service department at 1-866-4Denex1 (866-433-6391).

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. Please ask your provider to call
1-800-451-7715 to get more information on how to become a participating provider.

Do my dependents have to visit the same dentist that I visit?

No, you and your dependent 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 an out-of-network dentist?

If you visit a dentist out-of-network, you are responsible for paying the entire amount of the dentist’s usual and customary charge (non-discounted rate) at the time of service. You must then submit a claim form to Denex Dental so that we may process your claim.

How and when do I file a claim?

In-network provides 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 expeditiously mail you a concise explanation of benefits and reimbursement according to your plan guidelines. For questions regarding claims or benefits, please call: 1-866-4Denex1 (866-433-6391).

Where should I mail my claim?
Denex Dental Claims
P.O. Box 7402
London, KY 40742

For MD-IPA Claims ONLY:
P.O. Box 7402
London, KY 40742

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 recommends that you have your dentist submit a request for a pre-authorization for all services in excess of $300. This often applies to major services such as crowns, bridges, dentures, periodontics, and oral surgery. In addition, Denex Dental requires that all periodontal Scaling and root planning be submitted for pre-authorization. When your dentist suggests treatment, please have him or her send the treatment plan and necessary x-rays or periodontal charting to Denex Dental. A pre-estimate will be sent to both you and your dentist, detailing what services will be covered and at what payment level. If service is denied, you may be responsible for the difference between the dentist’s charge and the allowable reimbursement.

What happens after I fill out my enrollment form? How will I know when 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 on your group’s effective date. 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 card 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 Aetna DentalR PPO Netwrok. Your dentist should call the Denex Dental customer service department to verity eligibility.

 

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Denex Dental plans are underwritten by Group Dental Service of Maryland, Inc. (GDS-MD) 15400 Calhoun Drive, Suite 300, Rockville, MD 20855