Unlocking Your Dental Benefits: A Comprehensive Guide to Submitting Your MetLife Dental Claim
Ever wondered how to make the most of your MetLife dental benefits without the headache of complicated paperwork? You're in the right place! Navigating insurance claims can seem daunting, but with this step-by-step guide, you'll be a MetLife dental claim pro in no time. We'll walk you through everything, from gathering your documents to understanding your payment options. Let's get that reimbursement rolling!
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| How To Submit Metlife Dental Claim |
Step 1: Confirm Your Coverage and Understand Your Plan
Before you even think about submitting a claim, the very first and most crucial step is to understand what your MetLife dental plan covers. This will save you a lot of time and potential frustration down the line.
Sub-heading: What to Look For in Your Plan Details
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Policy Number: You'll need this for all communications and forms.
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Deductible: This is the amount you need to pay out-of-pocket before MetLife starts covering costs.
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Coinsurance: This is the percentage of the cost you're responsible for after meeting your deductible (e.g., MetLife pays 80%, you pay 20%).
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Annual Maximum: The total amount MetLife will pay for your dental care within a policy year.
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Covered Services: What specific dental procedures (e.g., cleanings, fillings, crowns, orthodontics) are covered and at what percentage.
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In-network vs. Out-of-network: Do you have a PPO plan that allows you to see any licensed dentist, or an HMO that requires you to choose a primary care dentist within their network? While PPO plans offer flexibility, going out-of-network usually means higher out-of-pocket costs.
Sub-heading: How to Access Your Plan Information
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Online Portal: The easiest way! Log in to your MyBenefits account on the MetLife website (
www.metlife.com/mybenefits -
MetLife Mobile App: Many MetLife features are available through their mobile app, making it convenient to access your information on the go.
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Employer (if applicable): If you have a group dental plan through your employer, your HR or benefits department can provide you with your plan summary and details.
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Customer Service: Don't hesitate to call MetLife Customer Service directly at 1-800-GET-MET8 (1-800-438-6388) for assistance. They can verify eligibility, explain your plan, and answer specific questions.
Step 2: Gathering the Necessary Documentation
Accuracy and completeness are key when it comes to dental claims. Having all your documents ready before you start the submission process will make it much smoother.
Sub-heading: Essential Documents You'll Need
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MetLife Dental Expense Claim Form: This is the primary form you'll need to fill out. You can usually download this from the MetLife website (
www.metlife.com/dental -
Detailed Invoice/Statement from Your Dentist: This is critical. It must include:
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Your name and the patient's name (if different).
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Date of treatment.
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Breakdown of treatments received, including ADA procedure codes.
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Associated cost for each treatment.
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Dentist's name, address, and license number.
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Dentist's signature.
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X-rays (if applicable): For certain procedures (e.g., crowns, root canals), MetLife may require X-rays to assess the medical necessity of the treatment. Your dentist will typically provide these directly to MetLife if needed, but it's good to be aware.
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Pre-treatment Estimate (if obtained): If you received a pre-treatment estimate from MetLife for a major procedure, keep a copy of this for your records. While not always required for claim submission, it can be helpful.
QuickTip: Ask yourself what the author is trying to say.
Sub-heading: Tips for Document Preparation
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Keep Originals: Always retain original invoices and receipts for your personal records. Submit copies to MetLife.
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Clarity is Key: Ensure all information on your documents is legible. If anything is handwritten, make sure it's clear and easy to read.
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Itemized Details: A simple receipt isn't enough. The invoice needs to be itemized with specific procedure codes and costs.
Step 3: Completing the MetLife Dental Expense Claim Form
Filling out the claim form correctly is paramount to avoiding delays in processing. Take your time and be thorough.
Sub-heading: Sections to Focus On
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Subscriber Information (Your Details):
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Full Name
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Address
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Date of Birth
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Employee ID Number (if applicable, usually your Social Security Number or a unique ID provided by your employer)
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Policy Number (Group Number is not always required, but the ID# is essential)
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Patient Information:
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Patient's Full Name
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Relationship to Subscriber (Self, Spouse, Child, Other)
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Patient's Date of Birth
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Dental Program and Services Received (to be completed by the Dentist):
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This section is typically filled out by your dental office. It will include details like:
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Date of service
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Tooth number(s)
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Surface(s) (for fillings)
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Description of services (e.g., "Prophylaxis - Adult," "Crown - PFM")
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ADA Procedure Number (the standardized code for each dental service)
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Fee for each service
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Payment Authorization:
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You'll likely find a section where you can authorize MetLife to pay your dentist directly (assignment of benefits) or to reimburse you. Choose the option that works best for you. If you want to be reimbursed, do not complete the section authorizing payment to the dentist.
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Signatures:
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Patient/Authorized Representative Signature: If the patient is a minor, a parent or legal guardian must sign. This authorizes the release of information related to the claim.
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Employee/Subscriber Signature: You must sign to certify the information is correct.
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Dentist's Signature: The treating dentist must sign to validate the services performed.
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Sub-heading: Common Pitfalls to Avoid
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Missing Information: Double-check every required field. Incomplete forms are a leading cause of processing delays.
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Illegible Handwriting: Print clearly or type.
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Incorrect Policy or ID Number: Ensure these numbers are accurate.
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Not Signing the Form: This is a surprisingly common oversight! Both the patient/authorized representative and the employee/subscriber signatures are vital.
Step 4: Submitting Your MetLife Dental Claim
MetLife offers several convenient ways to submit your claim. Choose the method that best suits your needs.
Sub-heading: Online Submission (If Available)
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This is often the fastest and most efficient method. Many MetLife plans allow for online claim submission through their MyBenefits website or mobile app.
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How it Works:
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Log in to your MyBenefits account.
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Navigate to the "Claims" or "Submit a Claim" section.
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Follow the prompts to enter the required information.
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Upload scanned copies of your detailed invoice/statement and any other supporting documents.
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Review all details and submit.
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Sub-heading: Mail Submission
Tip: Read once for gist, twice for details.
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If online submission isn't an option for your plan, or if you prefer traditional mail, this is a reliable method.
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Mailing Address: MetLife Dental Claims P.O. Box 981282 El Paso, TX 79998-1282
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Important:
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Use a sturdy envelope.
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Consider sending it via certified mail with a return receipt for proof of delivery, especially for larger claims.
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Include: Your completed MetLife Dental Expense Claim Form and all supporting documentation (copies, not originals).
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Sub-heading: Fax Submission
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Faxing can be a quicker alternative to mailing.
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Fax Number: 1-859-389-6505
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Important:
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Ensure your fax machine is working correctly.
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Keep a fax confirmation report for your records.
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Include: Your completed MetLife Dental Expense Claim Form and all supporting documentation.
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Sub-heading: Dentist Submitting on Your Behalf
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Many dental offices will submit claims directly to MetLife for you. This is often the most hassle-free option.
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What to Do:
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Confirm with your dental office if they handle electronic claim submission to MetLife.
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Provide them with your MetLife policy information (ID number, group number if applicable).
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Ensure they have all the necessary details from your visit.
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Even if they submit the claim, it's a good idea to obtain a copy of the completed claim form and your detailed invoice for your own records.
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Step 5: Tracking Your Claim and Understanding Your Explanation of Benefits (EOB)
Once your claim is submitted, the waiting game begins. But you don't have to wait blindly!
Sub-heading: How to Track Your Claim
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Online Portal: Your MyBenefits account is the best place to track your claim status. You can usually see when it was received, if it's being processed, and when a decision has been made.
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Customer Service: Call MetLife Customer Service (1-800-GET-MET8) and provide your policy number and claim details.
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Claim Processing Time: While processing times can vary, you can generally expect a response within a few weeks.
Sub-heading: Understanding Your Explanation of Benefits (EOB)
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Once your claim is processed, MetLife will send you an Explanation of Benefits (EOB). This isn't a bill, but a detailed statement explaining:
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The services you received.
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The total cost of those services.
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How much MetLife paid.
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The amount applied to your deductible.
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Your coinsurance responsibility.
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The remaining balance you owe (if any).
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Review Your EOB Carefully: Always compare your EOB with your dentist's bill to ensure accuracy. If there are discrepancies or you have questions, contact MetLife immediately.
Step 6: Receiving Your Reimbursement
Payment methods can vary.
QuickTip: Pay attention to first and last sentences.
Sub-heading: Direct Deposit or Check
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If you authorized direct payment to yourself, MetLife will either send a check to your mailing address or deposit the funds directly into your bank account if you've provided those details.
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If you assigned benefits to your dentist, MetLife will pay the dentist directly, and your EOB will reflect this. You will then only be responsible for any remaining balance to the dentist.
10 Related FAQ Questions
How to check my MetLife dental coverage?
You can check your MetLife dental coverage by logging into your MyBenefits account on the MetLife website (
How to get a MetLife dental claim form?
You can typically download the MetLife Dental Expense Claim form from the "Download Claim Form" section on
How to fill out the MetLife dental claim form correctly?
To fill out the MetLife dental claim form correctly, ensure you complete all sections for subscriber and patient information, the dentist accurately fills out the service details including ADA procedure codes and fees, and both you (the employee/subscriber) and the patient/authorized representative sign the form.
How to submit a MetLife dental claim online?
To submit a MetLife dental claim online, log in to your MyBenefits account on the MetLife website or mobile app, navigate to the claims section, enter the required details, and upload scanned copies of your detailed dental invoice/statement.
QuickTip: Focus on one paragraph at a time.
How to submit a MetLife dental claim by mail?
To submit a MetLife dental claim by mail, send your completed MetLife Dental Expense Claim Form and copies of your detailed dental invoice/statement to MetLife Dental Claims, P.O. Box 981282, El Paso, TX 79998-1282.
How to track the status of my MetLife dental claim?
You can track the status of your MetLife dental claim by logging into your MyBenefits account on the MetLife website, using the MetLife mobile app, or by calling MetLife Customer Service at 1-800-GET-MET8.
How to understand my MetLife Dental Explanation of Benefits (EOB)?
Your MetLife Dental EOB is a statement that details the services rendered, the cost, how much MetLife paid, how much was applied to your deductible/coinsurance, and your remaining responsibility. Compare it with your dentist's bill to ensure accuracy.
How to appeal a denied MetLife dental claim?
To appeal a denied MetLife dental claim, you typically need to submit a written request for review to MetLife within 180 days of the decision, providing your claim number, reason for appeal, and any supporting documentation. You can often find specific appeal instructions on your EOB or by contacting MetLife directly.
How to get reimbursed for out-of-network MetLife dental services?
If your MetLife plan is a PPO, you can still get reimbursed for out-of-network services by submitting a claim, but your out-of-pocket costs (deductibles, coinsurance, and balance billing) may be higher. Ensure your detailed invoice includes all necessary information for processing.
How to contact MetLife dental customer service?
You can contact MetLife dental customer service by calling 1-800-GET-MET8 (1-800-438-6388) for general inquiries, eligibility verification, and claim status. For international dental travel assistance, you can call 1-312-356-5970 (collect).
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