Insurance Predeterminations—Myths and Facts
San Francisco, Berkeley, Piedmont, & Oakland, California
Dental insurance is an important benefit that helps defray the costs of your valuable dental health care. Our Piedmont dentist and dentistry staff want to do everything we can to help you understand your insurance coverage and to help you maximize your benefits.
One question that comes up is about predetermination of benefits. Insurance companies would like patients to request authorizations for treatments which dentists have already determined are necessary. Patients feel that this will help to reduce the risk of unexpected costs. This sounds like a good idea, but what is this really all about? After all, if you have insurance coverage, shouldn’t the insurance company just pay their share when you have treatment?
- Preauthorization is an insurance company stall tactic. Insurance companies know that if treatment is delayed during the preauthorization process, there is a good chance it will not happen at all. This can lead to the well-known risks of no treatment such as extractions, root canals, infections and swelling. We now know that your dental health is directly related to your general health. Delaying treatment is not healthy.
- Preauthorization does NOT guarantee payment. Whenever a preauthorization is completed, insurance companies make it clear that final determination of benefits takes place only after treatment. If they deny authorization in advance, only the insurance company benefits.
Our San Francisco Bay area dentistry staff does not want our patients to be surprised or disappointed by the predetermination process. When treatment is recommended, there are often risks associated in waiting and predetermination does not guarantee payment. Our office and our patients have learned this from extensive experience in processing insurance. This is why our office does not recommend preauthorization or predetermination of insurance benefits.
We hope this information helps you to better understand your dental insurance. We are always happy to help you process your claims and to help you maximize your benefits.
