How to File a Claim
BU Dental Health Centers and BCBS Network Dentists
To obtain benefits for services provided at the BU Dental Health Centers or from a Blue Cross Blue Shield network dentist, show the dentist your Dental Blue Freedom identification card. The dentist will file the claim with Blue Cross Blue Shield. You do not have to file a claim form,
The following are procedures for obtaining benefits if your provider is not affiliated with a Boston University Dental Health Center and is not in the Blue Cross Blue Shield network:
- Obtain a claim form from Human Resources or from the website at www.bu.edu/hr /forms-documents.
- Pay your dentist for services.
Submit your claim form with original itemized bills within two years of the date you received the covered dental service to:
Blue Cross Blue Shield of Massachusetts
P.O. Box 986030
Boston, MA 02298
Blue Cross Blue Shield will review your claim, then reimburse you for the claim to the extent of your benefits described in this handbook.
Notice of Claim Decision
Notice of an adverse claim determination will be provided in writing in a culturally and linguistically appropriate manner and will include:
- the reasons for the denial, with reference to the specific provisions of the plan on which the denial was based;
- a description of any additional information needed to process the claim with an explanation of why the additional information is necessary;
- and an explanation of the claims review procedure.
Upon request and free of charge, you will be provided a copy of any internal rule, guideline, protocol, or other similar criterion that was relied upon in making the adverse determination regarding the claim, and an explanation of the scientific or clinical judgment for a determination that is based on a medical necessity, experimental treatment or other similar exclusion or limit.