See the D.A. Townley COVID-19 Update

Operating in a COVID World —

How do I submit a Dental Claim?

Check with your dentist; they may be able to submit your claim electronically on your behalf. If not, you’ll need to send us the claim.

Information needed to complete the form

  • member I.D. / Certificate Number
  • Group policy number
  • name of the insured person(s)
  • relationship to the employee
  • birth date(s)
  • service provided
  • original dentist statement or receipt or statement from your dentist or if you are coordinating claim’s payment with your spouse’s health plan, you should include the primary carrier’s payment statement
  • information about other benefit or insurance plans that you may be eligible to claim from.

Steps to complete and submit the form electronically

  1. Download the D.A. Townley standard Dental Health Claim form (English/French).
  2. Save the downloaded form to your computer.
  3. Open and complete Part 2 and Part 3 the form in Adobe Reader. DO NOT complete the form in your browser. Get Adobe Reader from here (it’s free).
  4. Save changes to your computer, then close and re-open the form to ensure your information was saved.
  5. Scan or take pictures of your dentist statement or receipt and primary carrier’s payment statement.
    Note: Our system only permits you to submit 9 receipts per claim!
  6. Email the saved Dental Claim form to health@datownley.com digitally using our secure Mail Express Tool. Here are the instructions on how to use it.
  7. Copy and save the Mail Express receipt number for your records.
  8. Do not print and mail the form to our offices.

 

Back to top