Pre-Treatment Estimates

Avoid surprises with a pre-treatment estimate (not applicable to DeltaCare^® USA). Before you start treatment, request an estimate to find out about:

• Contractual limitations or exclusions that apply to your treatment plan
• Delta Dental’s payment amount
• The patient’s payment portion

Advantages

• Helps you to determine how best to plan treatment: for example, treatment may be done in segments, over weeks, months or years, to incorporate all available benefits
• Enables you to develop a payment plan for the patient, taking into account what Delta Dental is expected to pay
• Receive e-mail notifications when new documents are available. Sign up for electronic statements

When to Request a Pre-Treatment Estimate

• Expensive or extensive treatment under consideration
• Dental plan limitations and/or exclusions may affect coverage

How to Request a Pre-Treatment Estimate

Transmit the proposed treatment plan electronically or mail a paper claim to Delta Dental. Include all required x-rays, documentation and/or written narratives. You will receive by mail a pre-treatment estimate showing the amount Delta Dental is estimated to pay and the amount of the patient’s responsibility. Unfortunately, we cannot provide pre-treatment estimates over the telephone.

Limitations

Keep in mind, the pre-treatment estimate is not absolute. It does not check the patient’s:

• Eligibility on the date of service.
• Incentive levels
• Maximum or deductible

If you need this information, please log in (or register if you have not already done so) to check benefits and eligibility online.

A pre-treatment estimate is not a guarantee of payment. When the services are complete and a claim is received for payment, Delta Dental will calculate its payment based on the enrollee’s current eligibility, amount remaining in his/her annual maximum and any deductible requirements.

How to Submit Claim for Payment

When the services are completed, submit a new claim for payment:

• Include on the claim only the services that were provided (omit services that weren’t provided, even if they were part of the original pre-treatment estimate)
• Include any additional services that were provided
• Submit the claim to Delta Dental as soon as possible after the services are completed (in all cases, submit claims not more than six months after the date of service)

We will process the new claim for payment using the current eligibility and benefits provisions.