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.
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
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
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
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.
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.
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
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
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