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MetLife has established a claim review procedure to ensure that you receive
all the benefits to which you are entitled.
The fact that
a dentist may recommend that a covered person receive a
dental service does not mean that:
- The dental
service will be deemed to be necessary; or
- Benefits
under this plan will be paid for the expenses of the dental
service.
MetLife
will make the decision as to whether the dental service is:
-
Necessary in terms of generally accepted dental standards;
and
-
Qualified for benefits under this plan.
If
you (or your beneficiary in the event of your death) file
a claim which is turned down in whole or in part, you will
be notified in writing with an explanation of the reason(s)
the claim was denied and which provisions of the Plan apply.
The explanation
will also inform you of your right to have a review of the
decision, and what you must do to request the review. You
will then have 60 days in which to appeal your claim in
writing to:
MetLife
Supervisor of Claims
Attn: University of Michigan
Dental Claim Unit
P.O. Box 981282
El Paso, TX 79998-1282
Requesting
a Review
When requesting a review, please state the reason you believe
the claim was improperly denied and submit any appropriate
data or questions. MetLife will review the claim and its
denial under the Plan provisions. You will be informed of
the decision in writing, in a timely manner, usually within
60 days.
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