Predetermination of Benefits

If a participant needs extensive dental work and the total charges will be in excess of $150, a Predetermination of Benefits is strongly recommended. This will help the participant and his or her dentist understand what is covered under the plan and what the participant's share of the costs will be before services are provided.

To request an advanced claims review, the participant and his or her dentist must complete a Dental Benefits Request (180k). The form is also available at the Aetna Navigator (https://member.aetna.com/). (Check your I.D. card for the applicable Aetna claims office address.) Aetna will review the dentist's description of planned treatment and expected charges.

Aetna will notify the participant's dentist of the benefits payable for the procedures. Once the treatment is finished, the participant's dentist will return the claim form with the description of the treatment and charges, showing the date the treatment was performed.