How to File a Claim

1. Claim forms and benefit schedules are also provided upon request from the Trust Fund Administrative Office or Allied Administrators, Inc. who are responsible for paying claims.


2. Complete the claim form in its entirety providing the full name of patient (omitting nicknames).


3. Discuss the Plan exclusions and limitations with your dentist and his fees for services. The Plan pays the expense incurred up to the amount shown in the Dental Comparison of Benefits, subject to an annual maximum of $2,000. For non-emergency gold and porcelain restorations, inlays, and crowns, and/or treatment plans exceeding $500, your dentist must include the services in a plan of treatment on a claim form and have it pre-authorized by Allied Administrators.


4. When your dental services are completed, the claim form should be signed by both you and your dentist and mailed to the below address, as shown on the form. Claims submitted without a member's signature will be returned. In addition, "signatures on file" for assignment and patient's release of information will not be accepted.
   
   IBEW-NECA Claims Administration
   (Allied Administrators, Inc.)
   2831 Camino del Rio South
   Suite 311
   San Diego, CA 92108-3829
   (800) 736-0401

   If you have any questions regarding claims, write or phone Allied Administrators, Inc.



5. For assistance or information regarding the Plan's summary of benefits, eligibility, exclusions & limitations, and coordination of benefits, contact the Membership Services Department of the Southern California IBEW-NECA Health Trust Fund at the following telephone numbers:  1-800-824-6935 or (323) 221-5861.
6. The staff of your dentist’s office may seek assistance or information regarding your eligibility, status of a claim, benefit coverage, claims submission information or pre-approval of services, by contacting Provider Customer Service at the following telephone number:  1-800-736-0401.