How to file a claim

Claims for dental care should be filed with the claims administrator
control room

COVID-19 Extension for Filing Claims and Appeals

Due to the COVID-19 Pandemic and Declaration of National Emergency, the US Departments of Labor (DOL) and Treasury/IRS have provided revised guidance that extends deadlines related to filing claims and appeals under ERISA plans. The guidance states that every affected individual gets an extension to take actions based on when their claims event occurred. This extension applies to the following deadlines discussed in this claims section:
  • Filing a claim;
  • Appealing a claim denial;
  • Requesting an external review; and
  • Filing information needed to complete/perfect an external review request.
The extension pauses the deadline to take the above actions until the “Outbreak Period” for that individual is over. For each claims event, the Outbreak Period ends on the earlier of:
  • One year after the period starts for that event; or
  • 60 days after the Declaration of National Emergency ends. (The Declaration was recently extended and is still ongoing.)
Essentially, the claims and appeals deadlines for the actions listed above are extended (delayed) until the earlier of one year after the Outbreak Period starts for that event, or 60 days after the emergency declaration ends. The normal deadlines then apply. Here is an example:

Assume the National Emergency does not end until November 30, 2022. Kendrick submits a claim on August 1, 2021. The claim is denied on August 5, 2021. Under the plan, Kendrick would normally have 180 days to appeal the claim. However, Kendrick’s Outbreak Period for his appeal does not start until he receives his claims denial. Kendrick’s Outbreak Period will end on August 4, 2022. He will have 180 days after that to submit his appeal.

The rules for these extensions are complex and subject to change. Please contact the bp Benefits Center for assistance. However, since the end of the extension period is currently unknown, please do not delay submitting your claim or appeal in a timely manner.

Deadline for filing claims

To receive benefits under the Dental Program, you must submit all claims to the applicable claims administrator within 12 months of the date of service. Any claims that the claims administrator receives more than 12 months after the date of service will not be paid.

Note: A claim/appeal can be made by you or your authorized representative (as determined by the claims administrator).

Need help with claims issues?

The Advocacy Service is available to help you with issues regarding health care claims and services. Advocacy team members work with you and the claims administrator to understand, research and resolve claims issues.

You must make at least one attempt to contact and resolve your issue directly with the appropriate claims administrator before contacting the Advocacy Service.

To reach the Advocacy Service, call the bp Benefits Center. Keep in mind that your issue may not necessarily be resolved in your favor, as the terms of the plan will apply in all situations.

What else you should know about the claims administrator

Cigna, the claims administrator for the Dental Program, is a business entity independent of bp. The claims administrator is solely responsible for making determinations regarding benefits based on the provisions of the Dental Program — moreover, because the DHMO is insured, Cigna is responsible for funding benefits under the DHMO. Neither bp nor the plan administrator will interfere in the decisions made by the claims administrator regarding benefits. Therefore, if you do not agree with the claims administrator’s determination regarding benefits, you must pursue the matter through the claims and appeals process.

If the DHMO fails to pay its network provider for services you receive, you may be individually liable to pay for such services. Additional financial assistance from bp will not be provided.

Submitting claims for out-of-network providers

To submit claims for expenses incurred with out-of-network providers, or if you have questions about how to file a claim, here is what you need to do:  

For …
Submit claims for expenses incurred
with out-of-network providers to ...
If you have questions about how to file
a claim, call ...

Dental PPO and DHMO claims

Cigna Dental Health
Client Services
300 NW 82nd Ave.
Plantation, FL 33324

1-800-367-1037

If you file a claim for benefits, an Explanation of Benefits (EOB) will be generated. The Cigna website also allows you to print this information, which you can keep for your records or use to file a claim for reimbursement from your Health Care Flexible Spending Account (HCFSA).

Health Savings Account (HSA) Debit Card

Your share of the cost for eligible dental expenses you incur may be paid to the provider through your PayFlex Card® (your HSA debit card), if you contribute to the HSA and have an available balance in your account. Note: You cannot use the HSA debit card outside the U.S.

 

Publication date: April 2019

 

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