Did you know that you can request a cost estimate for your next dental procedure before you even sit in the chair? We call this a pre-determination of benefits. A pre-determination of benefits is a great way to see what a procedure may cost and how much your dental plan will cover. You can request a pre-determination of benefits through your dentist at any time. Although it is not required, we actually recommend it for major procedures – just to avoid any potential surprises.
Here’s how to request a pre-determination of benefits:
1 – Ask your dentist to submit a pre-determination of benefits for the procedure you are having performed.
2 – They will then submit a request, using an ADA approved claim form. This will be considered a pre-treatment claim that is entered into our system. Our adjudicators will review and process it in the same manner as a claim, less any payment procedures. Dates are not required for a pre-determination, so it’s ok if you don’t have this appointment scheduled yet.
3 – Once the pre-determination has been reviewed (7 – 14 working days), an estimated cost breakdown will be sent to you and your dentist.
Now, you can schedule your next dental procedure with peace of mind, knowing you have a better understanding of what is covered. If you ever have questions about your coverage, feel free to give our customer care department a call at 800-999-9789, and we will happily discuss your plan with you.