Get Metlife Dental Hmo Continuing Orthodontic Treatment Request Form 2017-2026

Filling out the MetLife Dental HMO Continuing Orthodontic Treatment Request Form online is a straightforward process that helps ensure coverage for your ongoing orthodontic treatment. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete the form with accuracy and ease.

1. Click the ‘Get Form’ button to access the document and open it in your preferred online editing tool.
2. Fill in the Subscriber Information section. Ensure to provide your full name, Social Security number, street address (including apartment number if applicable), city, state, zip code, telephone number, company or organization name, and the name of your previous dental carrier.
3. Next, complete the Patient’s Information section. Provide the full name of the patient who is currently undergoing orthodontic treatment.
4. Move on to the Orthodontist Information section. This part needs to be completed by the patient's current orthodontist. Ensure to include the orthodontist's name, telephone number, street address, taxpayer identification number, city, state, and zip code.
5. Provide details regarding the patient's initial banding date, initial treatment term, remaining months of treatment, prior carrier agreed-upon full case amount, total orthodontic case amount, amount paid to date by the patient, and amount paid to date by the prior carrier.
6. Review the entire form to ensure all information is complete and accurate. Incomplete forms will be returned for correction, which may delay processing.
7. Once satisfied with your entries, save your changes. You can download, print, or share the completed form as required.

Complete the MetLife Dental HMO Continuing Orthodontic Treatment Request Form online today to ensure coverage for your orthodontic needs.