Pre-determination of Benefits

A claim procedure required by many health and dental care plans before you incur large expenses.

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It is generally recommended that if the expense is large and if there is any uncertainty as to what portion (if any) your insurance will cover, that you submit a pre-determination of benefits first.

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E.g. Your dentist advises that you get some major dental treatment. Your dentist's office can submit a pre-determination of benefits to the insurance company. The insurance company will review the recommended treatments, and will respond in writing letting you know exactly what amounts will be covered (if any).

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A pre-determination of benefits will help you in measuring whether you wish to proceed with a particular treatment.