Pre-Treatment Estimate tips

A pre-treatment estimate is an estimate of the amount that Delta Dental will cover and the amount the patient is responsible for.

You or your patients may request a pre-treatment estimate of benefits from Delta Dental at any time. A pre-treatment estimate is strongly recommended for extensive cases and/or cases which include procedures which may be affected by a program's limitations or exclusions. When a treatment plan is submitted for pre-treatment estimate, it is reviewed thoroughly to determine whether the treatment is covered by the patient's program. Delta Dental will send you an itemized statement of the estimated coverage under the plan. A pre-treatment estimate is not a guarantee of payment. Delta Dental can issue payment only if:

1. The patient was eligible on the date(s) of service;
   
2. The patient has not attained his or her annual (or plan year) maximum;
   
3. No other factors have come to Delta Dental's attention that would change the estimated benefit payment (such as the existence of other coverage, or changes in the patient's oral health).

When to get a pre-treatment estimate

Obtain a predetermination of costs for extensive cases that may be affected by a program's limitations and exclusions.

A pre-treatment estimate is not a guarantee of payment

To provide a faster turnaround, a pre-treatment estimate does not check a patient's current eligibility, incentive levels, maximum or deductible. If you need that information, please use our online benefits and eligibility service. Just register (if you have not already done so) and log in using the box near the top left of this page.

How to submit a pre-treatment estimate

Transmit the proposed treatment plan electronically or by paper to Delta Dental. You will receive by mail a pre-treatment estimate showing the estimated dollar benefit and the amount of the patient's responsibility. Pre-treatment estimates are not given over the telephone.

Once treatment is completed, submit a claim form for processing