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Aetna International - Dental Claim Form

Aetna International - Dental Claim Form 2026

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The document is a Dentist's Statement form that outlines the requirements for submitting dental claims when an itemized bill is not provided. It details the necessary information to be included in itemized bills, instructions for submitting claims, and guidelines for pre-treatment estimates. Additionally, it includes legal warnings about fraudulent claims and specifies the information required from both the patient and dentist.

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Click ‘Get Form’ to open the Aetna International - Dental Claim Form in our editor.
Begin by filling out the Patient Information section. Enter the patient's name, date of birth, and the employee's details including their Social Security/I.D. number and employer.
In the Dentist's Information section, ensure that the dentist completes all required fields, including their name, address, and license number. This is crucial if an itemized bill is not provided.
If applicable, indicate whether this is a request for a pre-treatment estimate or a statement of services rendered. Attach any necessary radiographs or models as indicated.
Complete the Examination and Treatment Plan section by listing all services performed in order from tooth number 1 through 32. Be sure to include dates and descriptions of each service.
Finally, review all entries for accuracy before signing and submitting your form along with any required documents to Aetna International.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do you file a dental claim?

Your dentist will submit your claim for you if theyre part of the network. If your dentist is not part of the network, you can: Ask them to submit claims for you, or. Complete a paper dental claim form and return it to The Standard.

How are dental claims billed?

A dental billing payment comes in two forms: Insurance payment and/or patient payment. Your dental billing process is your strategy for collecting from these two revenue sources.

How to submit a dental claim?

You may submit your dental claim electronically or use a paper form to receive payment for services. You are encouraged to directly submit your claims and pre-treatment estimates online through the provider portal or through a clearinghouse.

How long do I have to make a dental claim?

The usual time limit for bringing a dental negligence claim is three years. This can be either from the date the Client was injured or the date of knowledge, also known as the when the Client first realised they suffered an injury due to a potential dental negligence.

How do I contact Aetna International?

(Please dial 813-775-0190 collect/direct if the country you are in is not listed.) When prompted for the number you are calling, dial 877-248-3612. After the tone, you will hear an automated message stating thank you for using ATT and you will be directed to the Aetna International Member Service Center.

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Can Aetna be used internationally?

Aetna International provides quality health care and well-being benefits to your members living and working abroad. And the confidence of knowing someone is there to help them stay healthy and safe, no matter where they are in the world.

How do I claim dental work on my taxes?

Medical expenses include dental expenses, and in this publication the term medical expenses is often used to refer to medical and dental expenses. You can deduct on Schedule A (Form 1040) only the part of your medical and dental expenses that is more than 7.5% of your adjusted gross income (AGI).

Aetna International - Dental Claim Form 2026

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