Explanation of Benefits

It is important to understand the steps involved in processing and paying claims. Following is the typical sequence of events involved in claims processing:

• The dental office completes the claim form and submits it to your insurance company or administrator.
  
• The insurance company / administrator checks your eligibility.
  
• The procedure codes are compared to your dental plan to determine covered expenses and non-covered expenses.
  
• Covered expenses are applied against your deductible, co-insurance levels and the maximum benefit.
  
• The Explanation of Benefits (EOB) is sent to the employee. It explains how much was paid as a benefit and how much the patient is responsible for.

It generally takes between 7 and 20 calendar days for a dental claim to be paid.

Explanation of Benefits
The EOB contains all of the pertinent information concerning the claim payment and should be filed with your personal dental records. It includes:

Employee's name Employee's ID number Dentist who rendered services Patient's names Date processed Claim reference number Date services were performed The tooth or area numbers Procedure codes Fee charged PPO fee (if applicable) Covered expense Plan benefit Description of service Amount paid to dentist Patient's out-of-pocket expenses Amount paid towards maximum Phone number and address of claim office

Treatment Plan Questions
You need to know the answers to these questions before agreeing to a treatment plan:

• Do I understand the treatment alternatives being recommended?
  
• What are the advantages and disadvantages of each treatment option?
  
• Which options are necessary, elective or cosmetic?
  
• What are the fees for the recommended treatment?
  
• Are the fees reasonable?
  
• Should I submit the treatment plan for pre-determination of benefits?
  
• Is my dentist a member of my plan's Preferred Provider Organization (PPO) network?
  
• If my dentist is not a member of my plan's PPO network, will my dentist join the network so I can lower my out-of-pocket expenses?