Many patients ask, “Do I need a pre-determination”?
A pre-determination is an administrative process where we submit your recommended treatment to your insurance company so that they may review the procedures, consider your benefits and submit their determination to our office in writing. While some insurance plans require pre-determination (pre-d) prior to starting a procedure, most pre-d’s are requested to ensure payment from the insurance company for major services such as crowns, bridges and dentures.
In years past, insurance companies would “guarantee” benefits if returned via pre-d; however, most insurance companies now do not guarantee benefits, even if requested in writing. It is common practice now for insurance companies to report that a claim may only be approved for payment when received and your benefits reviewed.
While we haven’t had any instances where they deny a claim once approved via a pre-d, we highly recommend you review your plan carefully for any exclusions, limitations or details that may not be relayed to us when we call to verify your benefits. We strive to provide accurate estimates for your dental care as based upon information received from your insurance company but please keep in mind that we cannot guarantee benefits.
In fact, we have a dedicated Insurance Coordinator on staff. Whether you are wondering if you need a pre-determination or just have some general questions, Rachel is happy to answers questions or assist you with your dental insurance plan. Please feel free to call her at 919-355-1170.