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When you use dental insurance benefits, you must be “eligible” for such benefits. Some benefits require pre-authorization.
Pre-authorization is basically a second opinion by a dental consultant who is employed by the insurance company or trust to review all work submitted according to the requirements of your insurance carrier. This dental consultant will determine if the recommended treatment will be authorized for payment. Sometimes pre-authorization can take up to six weeks.
Eligibility is a set of employment rules that the employer or union has developed that allows you to have continuing dental benefits. Often eligibility is based on the number of hours worked, length of employment, probationary periods, leaves of absences, enrollment periods, transfers, and other conditions as determined by the employer.
Pre-authorization does not assure continuing eligibility. You may in fact be eligible for dental benefits but denied authorization for specific treatment based on the decision of the dental consultants. Likewise, the dental consultants may authorize treatment, but you may fail to meet eligibility requirements at the time the treatment was completed. Always know your eligibility requirements. Contact your employer for information.
Desert Pearl Dentistry is a Preferred Provider for these PPO plans:
- Delta Dental
- First Dental Health
- Local Advantage
- United Concordia
We also honor UFCW fees. Desert Pearl Dentistry does not accept HMO or DPO plans.
Each month you will receive a statement that reflects dental service performed and billing charges. As a courtesy to our patients, we allow a 45-day grace period for your insurance company to make payment. However, if after 60 days we have not received payment from your insurance company or there is a dispute between the insurance company and our office regarding payment of services, you will be asked to contact them. Insurance is designed to reimburse the policyholder and you, therefore, are ultimately responsible for payment of services. Your cooperation in responding to our request for assistance in this matter will not only keep your account up to date, but will help prevent you from being financially responsible for payment as well as late charges. Review your statements carefully. Please call if you have any charges in the 61-90 day column of your statement. Keep your statements. They are part of your dental records and may be very helpful if you have questions about treatment.