Are the difficulties of understanding dental benefits leaving you feeling lost and confused? Follow us out of the dark as we make understanding dental benefits simple! We’re explaining what a Delta Dental pre-treatment estimate is. It’s like a crystal ball for gazing into the future of your dental bills and oral health!
A Delta Dental Pre-Treatment Estimate Can Be Your Personal Crystal Ball
Before you agree to treatment, ask your dentist for a Delta Dental pre-treatment estimate, also called a pre-determination of benefits. Asking for this before you undergo treatment gives you the power to know the costs before you commit.
Once the dentist receives your request, he or she will submit their recommended treatment plan to Delta Dental. Your x-rays may come along, too, for extra information. No need to worry about finding a dental estimate form! Just ask, and your dental office will submit your information to us.
Once we have this information, we will review the documents, the recommended procedures and your benefits plan.
Pre-treatment estimates are only sent to the dentist who submitted the services, but you are always welcome to contact us and obtain a copy! Or you may ask your dentist to provide you with a copy.
When Would I Use A Pre-Treatment Estimate?
We encourage you to request a pre-treatment estimate prior to the start of extensive dental work. We recommend one be submitted if your treatment needs could exceed $250. A Delta Dental pre-treatment estimate is most often requested for costly procedures such as crowns, wisdom tooth extractions, bridges, dentures, and oral surgery.
A pre-treatment estimate is offered to any member seeing any type of dental provider participating with us. We recommend thinking about the processing of your pre-treatment estimate exactly as you would think about the processing of your claim.
Delta Dental reviews the planned treatment and expected charges. Then, we will let your dentist know:
- If the services are a covered benefit on your specific plan,
- If the plan can consider payment,
- And what the member will owe before having the services rendered.
Remember, a Delta Dental insurance pre-treatment estimate is only valid for 90 days!
How to Read a Delta Dental Pre-Treatment Estimate
Once you have it in hand, you’ll want to know how to read a Delta Dental pre-treatment estimate. There’s no good in a crystal ball without a fortune teller to read it, right?!
On the estimate is a series of columns and numbers. Your “Procedure Code” and “Procedure Description” columns help us and your dentist identify the treatment requested.
The “Submit Amount” and “Fee Adjustment” columns show how much your dentist charged for that treatment. The “Approved Amount” or “Allowed Amount” usually have the same number, which reflects the approved amount that the dentist wants to charge for treatment. The two may differ based on your coverage.
Since Delta Dental may not cover every treatment your dentist recommends, the “Deductible Applied” column number shows the amount left over that you would be responsible for paying. This payment would contribute to your deductible.
The “Delta Dental Co-Pay” column, also known as “Co-Pay Percent” or “Benefit Level” will reflect the percent of the cost that Delta Dental will cover. This is based on your plan’s coverage and the dentist’s treatment recommendations. If everything your dentist recommends is covered, this column will reflect “100%.”
Preventive treatments are usually covered at 100%, while basic and major procedures usually aren’t fully covered. That means daily healthy smile habits keep money in your pocket!
If Benefits Change, Your Pre-Treatment Estimate Will, Too
The Delta Dental pre-treatment estimate that we provide is just that – an estimate. A pre-treatment estimate is not a guarantee, but a hypothesis of the costs you will be responsible for. If your benefits change before the treatment is completed (or starts), the estimate won’t be accurate. The following actions will also render a pre-treatment estimate inaccurate:
- Loss of coverage
- Changes in your dentist’s participation with us
- Services outside your plan rendered
- Changes to dental codes or treatment made
- Changes in appointment location
- Changes to your dental provider
A pre-treatment estimate is, however, more accurate than a basic cost estimator like this one. That’s because we factor in:
- Your personal dental plan,
- Your plans eligibility,
- Current plan benefits,
- The network status of your treating dentist,
- And fluctuating factors, like the amount remaining in your annual maximum.
Your estimate will detail how coinsurance or copayments, deductibles, and dollar maximum limits impact what you pay. We use many sources of information to draw up your pre-treatment estimate. But, we are usually able to return them in just a matter of days!
More complex treatments may require extra assessment. If you have questions, contact us and we’d be happy to look into your benefits plan.