A pre-determination of benefits is a helpful tool that allows you and your patient to know in advance what procedures are covered by insurance, the amount the patient's dental plan will pay toward the treatment, and what the patient's financial responsibility will be.
Depending on a patient's plan, a predetermination may be required before certain treatments are performed. We encourage pre-determinations for extensive treatments like dentures, implants, TMJ, orthodontics, crowns, etc.
Requests for pre-determinations are made by submitting a proposed treatment the same way you would a regular claim - just omit the dates of service and the dentist's signature. You can also easily submit a Pre-determination online through your dentist account. Pre-determinations are valid for 6 months - you can easily extend their expiration date by calling or emailing our Customer Service team to request an extension at 800.234.3375 or firstname.lastname@example.org.
If you have questions about pre-determinations, contact your Professional Relations Representative or email email@example.com.