What is a pre-determination?
A pre-determination is a helpful way to better understand your dental insurance benefits before starting treatment. It’s a request sent to your dental plan provider asking them to review the proposed treatment and outline what services may be covered and what portion they may pay.
While we try to assist with insurance queries, please keep in mind that our office is not an expert on the details of your individual insurance plan. Coverage, limits, and eligibility can change, so we encourage you to stay informed about your specific benefits. At your request, we can prepare an estimate and pre-determination for your proposed treatment so you can submit to and receive information from your insurance provider.
We recommend checking with your insurance provider to see whether a pre-determination is required, as some plans may require one before treatment begins. Please note that pre-determinations are time-sensitive and may change if you reach your plan’s maximum, experience a change in employment, or if your plan’s terms are updated.
Any portion of treatment costs not covered by your insurance plan will be the patient’s responsibility.
Why did my dental insurance plan decline my pre-determination?
There are several reasons why a pre-determination may be declined. In some cases, you may have reached the maximum coverage allowed under your plan, or the recommended treatment may not be covered by your insurance. Please remember that treatment recommendations are based on your individual oral health needs, rather than the limitations of an insurance plan.
If you have questions or concerns, we encourage you to review your plan details and contact your insurance provider directly for clarification. They’ll be able to explain your benefits and coverage in more detail.
What is the difference between assignment and non-assignment of benefits?
Assignment of Benefits (also known as Third-Party or Direct Billing) means that your insurance provider pays the dental office directly for the portion of treatment covered under your plan. You, as the patient, are then responsible for paying any remaining balance.
At a non-assignment-of-benefits office, the full cost of treatment is paid at the time care is provided. The office will supply you with a completed dental claim form, which you can submit to your insurance provider for reimbursement. While this means you may still receive money back from your plan, the claim submission and reimbursement timeline are managed directly between you and your insurance provider.
Please note that our office does not accept assignment of benefits. Once your treatment is complete, we will provide all necessary documentation to support your insurance claim.
If paying the full amount upfront is a concern, financing options are available. For more information, please refer to dental finance in the “Appointments” section in the toolbar.
If you wish, a quote or predetermination can be issued before treatment commences.
