Your card. Your dental health. - Premera Blue Cross

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ClaimsFiling a claim when using an out-of-network dentistWhen you see a dentist outside of our network, you may have to pay for the services up frontand submit the claim yourself. (In-network dentists submit the claim for you.)File a claim:1. Download a claim form from the “Forms” sectionon premera.com, and complete.2. Attach an itemized bill from your dentist and proofof payment for the covered service.3. Make a copy for your records.4. Mail your claim to the address on the claim form.Status of a claimLog in to premera.com, go to “My PlanInformation” and check your claim’s status.Question a claimIf you have an issue with a processed claimand would like us to review it, call CustomerService at 800-508-4722. You must make yourrequest within 180 days after you receive yourExplanation of Benefits (EOB).You can also submit a request in writing.Include a copy of the EOB you want reviewedand any other documentation that maysupport your inquiry. Send in this requestwithin 180 days of receiving the EOB to:Premera Blue Cross Blue Shield of AlaskaPO Box 240609Anchorage, AK 99524-0609We’ll send you more details about the reviewprocess once we receive your request.10
Thank youWe are proud to have servedAlaskans for over half a century.Alaskans choose Premera Blue Cross Blue Shield ofAlaska more than any other health plan. We delivercomplete benefit solutions, programs and toolsthat actively promote better health outcomes andhelp achieve sustainable healthcare costs.
Page 1 and 2: Your card. Your dental health.
Page 3 and 4: Know how your dental plan works.Sav
Page 5 and 6: Access our dental providernetwork a
Page 7 and 8: Free online member tools.Inform and
Page 9: When you use an in-network dentist,

Your card. Your dental health. - Premera Blue Cross

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