Aetna Health Insurance Dental Forms

Aetna health insurance dental forms must be submitted in order for the provider to receive payment.

Aetna Health Insurance Dental Forms Overview

According to the Aetna website, if you visit an in-network provider, it is the provider's responsibility to complete and submit the forms. Even some out-of-network providers will submit forms on your behalf. In the event that you're billed in full for services and need to submit the proper claim forms, you can do so through the company's website.

Aetna offers three different types of dental insurance. Each policy has a different premium or cost. Some provide a discount for services while others completely cover the cost of routine care but may have a co-payment or deductible for more extensive treatment.

Dentist working on a patient

How to Use the Form

Aetna expects dentists or their staff to complete the insurance claim forms. If you've visited a provider and he does not complete the forms for you, you can download and print them yourself. You will need Adobe Acrobat to open the two-page form.Forms may be used for two purposes: to request an estimate of what benefits are covered for the patients or to request reimbursement.

  • Estimates: Dental treatment can be expensive. If your dentist recommends many treatment options, you can use the dental claim forms to request an estimate from Aetna on how much they will cover. Your dentist needs to give you a complete list of treatment plans he recommends, indicating which tooth or teeth need the treatment. Teeth are numbered on a diagram in the dental office and your dentist will refer to the teeth by number. This information helps the Aetna insurance personnel review your dental health file and determine which treatments will be covered under your insurance plan and how much the company will pay. They will mail you a written estimate and you have a chance to review it, compare it to your dental insurance policy, and call the company to discuss any questions or concerns you may have. Estimates are called "predetermined benefits" on the form.
  • Payment: As with all insurance claim forms, dental insurance claim forms are submitted to request payment from the insurance company for services performed by a health care provider. If you paid the dentist in full for the treatment at the time of visit, there's a box to check on the form to ask that payment be sent to you. If your dentist has agreed to wait for payment until you see what the insurance will cover, you can ask that payment be sent directly to the dentist. If that's the case, expect your dentist to bill you for the difference between what his stated fees and what the insurance covers; that amount is your responsibility to pay. Some dentists waive this additional fee.

Required Information

Like most health insurance forms, Aetna health insurance dental forms ask for information to accurately identify the policy holder or member, the person receiving the treatment, and the policy itself. You will need to complete the top portion of the form by providing your:

  • Legal name
  • Address
  • Birth date
  • Social Security number
  • Work and home contact information
  • The name, Social Security number and birth date of the person receiving the service as in the case of a minor child covered under the policy

The next section of the form asks specifics about the dental treatment. There is a diagram of the mouth with each tooth indicated. The company asks that an X be placed on any teeth that are missing; this prevents anyone from accidentally billing for treatment on a tooth that doesn't exist. You will need to get the precise information on the treatment suggested, the tooth that needs the treatment, and other dental information directly from your dentist's office. You'll also be asked to write down the dentist's name, address, and telephone number. Aetna may call the dental office to ask questions about the claim or confirm the treatment information included on the form.

One thing that confuses many people filling out this form is the term "Procedure Number" on the chart at the end of the form. The American Dental Association created a set of standard codes for dental procedures, also called Procedure Codes. The safest and most accurate way to get these for your Aetna claim form is to ask your dentist for the codes.

Lastly, be sure to include copies of your dentist's reports and any x-rays or treatment records he provides to you for the claim. Sign the claim form and keep a copy for your records. Remember, it is a crime to falsify information on medical or dental insurance claim forms.

Forms may be mailed to Aetna Dental, PO Box 14094, Lexington KY 40512-4094.

Time for Payment

It can take several weeks for the claim forms to be reviewed and payment remitted to either you or to the dentist. Be patient, but call if more than eight weeks go by without a phone call or letter from Aetna. It's possible the claim was misplaced or lacks crucial information for the company to complete it and remit payment.