Dental Benefits Overview
Understanding your dental benefits can improve your health and lower your out-of-pocket expenses.
Filing a claim
It is important to understand the steps involved in processing and paying claims. Following is the typical sequence of events involved in claims processing:
- The dental office completes the claim form and submits it to your insurance company or administrator.
- The insurance company / administrator checks your eligibility.
- The procedure codes are compared to your dental plan to determine covered expenses and non-covered expenses.
- Covered expenses are applied against your deductible, co-insurance levels and the maximum benefit.
- Your dentist is paid. It generally takes between 7 and 20 calendar days for a dental claim to be paid.
- You receive an EOB (Explanation of Benefits). It explains how much was paid as a benefit and how much you are responsible for. It contains all of the pertinent information concerning the claim payment and should be filed with your personal dental records. It includes:
- Employee's name
- Employee's ID number
- Dentist who rendered services
- Patient's name
- Date processed
- Claim reference number
- Date services were performed
- The tooth or area numbers
- Procedure codes
- Fee charged
- PPO fee (if applicable)
- Covered expense
- Plan benefit
- Description of service
- Amount paid to dentist
- Patient's out-of-pocket expenses
- Amount paid towards maximum
- Phone number and address of claim office