What is a predetermination?
Predetermination is a voluntary, optional procedure where Delta Dental issues a written estimate of benefits that may be available under your plan for your proposed dental treatment. Your dentist submits the proposed dental treatment to Delta Dental in advance of providing the treatment.
When should I request a predetermination from my dentist?
You can request a predetermination at any time; however, specific instances when you may want to request one include:
- If your dentist is recommending extensive treatment
- If you need information on benefit coverage and plan limitations
- If you would like an estimate of how much you may have to pay
How long does it normally take to receive a predetermination?
If all information is received with the initial request for predetermination, please allow 10–14 business days for processing. To receive a predetermination even faster, have your dentist submit the request online.
Note: Predetermination is provided for informational purposes only and is not required before you receive any dental care. It is not a prerequisite or condition for approval of future dental benefits payment. You will receive the same benefits under your plan whether or not a predetermination is requested. The benefits estimate provided on a predetermination notice is based on benefits available on the date the notice is issued. It is not a guarantee of future benefits or payment.
Availability of benefits at the time your treatment is completed depends on several factors such as, but not limited to, your continued eligibility for benefits, your available annual or lifetime maximum payments, any coordination of benefits, the status of your plan and the dentist, your plan's limitations and any other plan provisions. A request for a predetermination is not a claim for benefits or a preauthorization, precertification or other reservation of future benefits.