Get Aanvraag Tot Tegemoetkoming Denta Plus - Lmbe

Filling out the AANVRAAG TOT TEGEMOETKOMING DENTA PLUS - Lmbe is essential for obtaining reimbursement for dental care services. This guide provides clear and supportive instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click the 'Get Form' button to access the form and open it in your preferred PDF editor.
2. In the section labeled 'GEGEVENS IN TE VULLEN DOOR DE VERSTREKKER', the dental provider needs to fill in the patient's identity details. This includes listing the type of care provided, the relevant dental number or quadrant, the date of provision, and the nomenclature number if applicable.
3. There will be several subsections under care types. Fill out the subtotal for each type of service, such as preventive care, curative care, periodontics, and prosthetic treatments. Be sure to indicate the specific treatments given and their corresponding subtotal.
4. For the orthodontics section, if applicable, include the installation date of the orthodontic device. Again, provide the subtotal for this treatment.
5. Once the dental provider has completed their section, move to 'GEGEVENS IN TE VULLEN DOOR DE VERZEKERDE OF DE WETTELIJKE VERTEGENWOORDIGER'. Here, fill in personal details such as the insurance number, name, contact address, phone number, and preferred account for reimbursement.
6. Answer the questions regarding whether the dental care was a result of an accident and if there is coverage from another insurance. If applicable, provide the necessary details.
7. Sign the form at the end to confirm that the information provided is complete and accurate. This is a crucial step, as it allows your insurance company to access any necessary billing information related to your treatment.
8. Attach any supporting documents required, such as the certificate of care provided or an invoice if no reimbursement from mandatory health insurance is applicable.
9. Finally, you can save your changes, download the completed form, print it, or share it as needed.

Complete your AANVRAAG TOT TEGEMOETKOMING DENTA PLUS - Lmbe online to ensure smooth processing of your dental reimbursements.