Determining covered procedures
Pre-determination is an administrative procedure performed prior to treatment. It is in your best interest to utilize the pre-determination process so you are not surprised with unexpected dental expenses after the work is completed. The pre-determination process begins when your dentist submits your proposed treatment plan to the claim office. The claim office will process it and send your dentist an explanation of benefits (EOB) that describes:
- Whether you are eligible for benefits.
- What is considered a covered expense.
- How much is covered by the plan.
- The application of appropriate deductibles, co-payments and/or maximum limitations.
- Your potential out-of-pocket expenses.
- Appropriate alternative treatment options.
Pre-determinations are encouraged for more expensive treatment plans.