A procedure where a provider submits a treatment plan to the health insurer before treatment begins. The insurer reviews the treatment plan and notifies the provider of one or more of the following: patient's eligibility, covered services, amounts payable, co-payment and deductibles and plan maximums.
a submission sent to the insurance company prior to treatment to determine how much they will pay toward your root canal
To determine before treatment the maximum dollar amount the insurance company will pay for surgery, consultations, postoperative care, and so forth.
A breakdown of how benefits would be covered by a member's certificate of coverage when a dental provider submits an estimate of services.
a review process conducted by an insurance company to verify the medical necessity of a planned procedure or treatment. Predetermination is often a condition of a health plan payment to the participant.
The amount of benefit that an insurance company agrees to pay for a procedure determined prior to the patient receiving treatment.
An administrative procedure that may require the dentist to submit a treatment plan to the third party before treatment is begun. The third party usually returns the treatment plan indicating one or more of the following: patient's eligibility, guarantee of eligibility period, covered services, benefit amounts payable, application of appropriate deductibles, co-payment and/or maximum limitation. Under some programs. predetermination by the third party is required when covered charges are expected to exceed a certain amount, such as $200.
The process of obtaining an estimate of what an insurance company will pay for service(s) before the service(s) is performed.
An administrative procedure whereby a health provider submits a treatment plan to a third party before treatment is initiated. The third party usually reviews the treatment plan, monitoring one or more of the following: patient's eligibility, covered service, amounts payable, application of appropriate deductibles, copayment factors and maximums. Under some programs, for instance, predetermination by the third party is required when covered charges are expected to exceed a certain amount. Similar processes: pre-authorization, pre-certification, pre-estimate of cost, pretreatment estimate, prior authorization.
Dentists may submit their treatment plans to Delta Dental for review and estimation of coverage before procedures are started. Delta Dental advises the patient and dentist of what services are covered and what payment may be. Actual payment for predetermined services depends on eligibility and the remaining maximum at the time services are rendered.
Gives an estimate of how much of a proposed treatment plan will be covered under your dental program. A predetermination lets you figure your costs before you receive major treatment. Any enrollee can ask the dental office to submit a predetermination request.
An administrative procedure that requires your endodontist to submit a treatment plan to your insurance carrier for approval before treatment begins.
The doctor notifies the insurance company of the treatment before it begins. The insurance company estimates the benefits that will be paid. This is not a guarantee of payment. Also known as “pre d,” pre-certification, “precert,” “precert.” “Pre-authorization” and “preauth.
