Dental plan terminology: predetermination of benefits
A predetermination of benefits is a written estimate from your dental insurer of the amount your dental plan will pay for a specific treatment based on information provided by your dentist.
SDC's predetermination process is helpful for both the patient and the treating dentist. Predeterminations ensure the proposed service is covered by the dental plan and allows you, the patient, to understand what your financial responsibility will be. Since documentation requirements are satisfied before treatment begins, predeterminations can also expedite claim payment.
You can ask your dentist to submit a predetermination of benefits to SDC for any treatment or service before it is performed. It is necessary for a dentist to submit a predetermination when a proposed treatment plan exceeds $400.00 or includes periodontal treatment. Once your dentist submits a predetermination form to SDC, it will be reviewed by SDC's dental consultants (who are licensed dentists), estimated benefits will be determined, and the predetermination of benefits document will be generated and mailed to both you and your dentist.