Dac Message 1278

To be considered for reimbursement of dental expenses, you must submit a statement from your dental provider identifying the date the dental injury or illness occurred and if it was disaster related. Please include the name, address, and phone number of the provider(s) of dental service(s), and a copy of the itemized bill/receipts from the provider.<br>

For reimbursement of costs related to loss of Prescription Medication, include the pharmacy receipt showing the replacement cost of the medication, written verification from the pharmacy showing the prescription was filled prior to the disaster, and written verification from the dentist stating your condition requires the medication.<br><br>

If you have dental insurance you must also submit either the written denial from your insurance carrier or the explanation-of-benefits statement for the amount(s) which they have covered.<br>

If you are NOT covered by Dental insurance, please sign and date the Statement of Insurance form at the bottom of your letter, return it with the provider information and requested receipts.