Common use of Disputed Claims Procedure Clause in Contracts

Disputed Claims Procedure. If you have reason to believe your benefit determination was not in accordance with the terms of your plan, you have the option of using Delta Dental’s Disputed Claims Procedure. This may be requested within six (6) months of the date of Northeast Delta Dental’s original Explanation of Benefits. It is recommended that your written request for a review of your claim be personally delivered or mailed certified mail, return receipt requested, to the Director, Professional Relations, Northeast Delta Dental, Xxx Xxxxx Xxxxx, XX Xxx 0000, Xxxxxxx, Xxx Xxxxxxxxx, 00000- 2002, but you may also submit your request by standard mail. Your request for a review of your claim should refer to the claim(s) in question, state your name and address, and the reasons you think the denial should be evaluated. You may provide any additional materials you wish to present. The Director, Professional Relations, or his/her designee, may request additional documents as necessary to make such a review and will promptly review your claim. If the claim is Xxxxxx, you will be furnished with a written notice of the decision within thirty (30) days after receipt of the disputed claim. The written notice will include:

Disputed Claims Procedure. If you have reason to believe your benefit determination was not in accordance with the terms of your plan, you have the option of using Delta Dental’s Disputed Claims Procedure. This may be requested within six (6) months of the date of Northeast Delta Dental’s original Explanation of Benefits. It is recommended that your written request for a review of your claim be personally delivered or mailed certified mail, return receipt requested, to the Director, Professional Relations, Northeast Delta Dental, Xxx Xxxxx Xxxxx, XX Xxx 0000, Xxxxxxx, Xxx Xxxxxxxxx, 00000- 00000-2002, but you may also submit your request by standard mail. Your request for a review of your claim should refer to the claim(s) in question, state your name and address, and the reasons you think the denial should be evaluated. You may provide any additional materials you wish to present. The Director, Professional Relations, or his/her designee, may request additional documents as necessary to make such a review and will promptly review your claim. If the claim is XxxxxxXxxxxx in any respect, you will be furnished with a written notice of the decision within thirty (30) days after receipt of the disputed claim. The written notice will include:

Disputed Claims Procedure. If you have reason to believe your benefit determination was not in accordance with the terms of your planthis policy, you have the option of using Northeast Delta Dental’s Disputed Claims Procedure. This may be requested within six (6) months of the date of Northeast Delta Dental’s original Explanation of Benefits. It is recommended We recommend that your written request for a review of your claim be personally delivered or mailed certified mail, return receipt requested, to the Director, Professional Relations, Northeast Delta Dental, Xxx Xxxxx Xxxxx, XX Xxx 0000, Xxxxxxx, Xxx Xxxxxxxxx, 00000- 00000-2002, but you . You may also submit your request by standard mail. SAMPLE Your request for a review of your claim should refer to the claim(s) in question, state your name and address, and the reasons you think the denial should be evaluated. You may provide any additional materials you wish to present. The Director, Professional Relations, or his/her designee, will promptly review your claim. He/She may request additional documents as necessary to make such a review and will promptly review your claimreview. If the claim is XxxxxxXxxxxx in any respect, you will be furnished with a written notice of the decision within thirty (30) days after receipt of the disputed claim. The written notice will include:

Disputed Claims Procedure. If you have reason to believe your benefit determination was not in accordance with the terms of your plan, you have the option of using Delta Dental’s Disputed Claims Procedure. This may be requested within six (6) months of the date of Northeast Delta Dental’s original Explanation of Benefits. It is recommended that your written request for a review of your claim be personally delivered or mailed certified mail, return receipt requested, to the Director, Professional Relations, Northeast Delta Dental, Xxx Xxxxx Xxxxx, XX Xxx 0000, Xxxxxxx, Xxx Xxxxxxxxx, 00000- 2002, but you may also submit your request by standard mail. Your request for a review of your claim should refer to the claim(s) in question, state your name and address, and the reasons you think the denial should be evaluated. You may , and provide any additional materials you wish to present. The Director, Professional Relations, or his/her designee, may request additional documents as necessary to make such a review and will promptly review your claim. If the claim is XxxxxxXxxxxx in any respect, you will be furnished with a written notice of the decision within thirty (30) days after receipt of the disputed claim. The written notice will include:

Disputed Claims Procedure. If you have reason to believe your benefit determination was not in accordance with the terms of your planthis policy, you have the option of using Northeast Delta Dental’s Disputed Claims Procedure. This may be requested within six (6) months of the date of Northeast Delta Dental’s original Explanation of Benefits. It is recommended We recommend that your written request for a review of your claim be personally delivered or mailed certified mail, return receipt requested, to the Director, Professional Relations, Northeast Delta Dental, Xxx Xxxxx Xxxxx, XX Xxx 0000, Xxxxxxx, Xxx Xxxxxxxxx, 00000- 00000-2002, but you . You may also submit your request by standard mail. Your request for a review of your claim should refer to the claim(s) in question, state your name and address, and the reasons you think the denial should be evaluated. You may provide any additional materials you wish to present. The Director, Professional Relations, or his/her designee, will promptly review your claim. He/her may request additional documents as necessary to make such a review and will promptly review your claimreview. If the claim is XxxxxxXxxxxx in any respect, you will be furnished with a written notice of the decision within thirty (30) days after receipt of the disputed claim. The written notice will include: