Insurance Predeterminations, Myths and Facts


Insurance Predeterminations – Myths and Facts

San Francisco, Berkeley, Piedmont, & Oakland, California

Many of our valued clients use their personal or corporate dental insurance as a way to limit or defray the costs of their dental health care. At our Piedmont dentistry office, we want to do everything we can to help you understand your insurance coverage and to help you maximize your benefits, including understanding the ways dental insurance companies try to avoid paying for procedures.

One key aspect to dental insurance is the requirement for patients to attain preauthorization for procedures to be covered. Insurance companies often require their clients to request authorizations for treatments which dentists have already determined are necessary. Patients feel that this will help to reduce the risk of unexpected costs, and while this is often the case, there’s actually a lot going on in this process, and it doesn’t always work out as planned.

In our practice, we have often found reauthorization to be nothing more than an insurance company stall tactic. Insurance companies know that if treatment is delayed during the preauthorization process, there is a good chance it will not happen at all, as patients grow impatient and give up, or merely forget to follow up with their insurance companies. This can lead to the well-known risks of putting off treatment such as extractions, root canals, infections and swelling. We now know that your dental health is directly related to your general health. Delaying treatment is not healthy.

It is important to remember that regardless of treatment or dentist, preauthorization does NOT guarantee payment. Whenever a preauthorization is completed, insurance companies make it clear that final determination of benefits takes place only after treatment. If they deny authorization in advance, only the insurance company benefits.

Our San Francisco Bay area dentistry staff does not want our patients to be surprised or disappointed by the predetermination process. When treatment is recommended, there are often risks associated in waiting and predetermination does not guarantee payment. Our office and our patients have learned this from extensive experience in processing insurance. This is why our office does not recommend preauthorization or predetermination of insurance benefits without the knowledge that you may be surprised with a bill after the fact that you weren’t expecting.

We hope this information helps you to better understand your dental insurance. We are always happy to help you process your claims and to help you maximize your benefits.