Insurance Flashcards
What insurance plan are ALL providers out of network with?
Cigna
A patient states they have Deltacare. Are we in network with this plan?
NO. Deltacare is an HMO plan
Name some insurances that follow the Connection Dental Fee schedule
Connection Dental/GEHA
Aetna/Principal
BEAM
Blue Cross Blue Shield of Alabama
Dental Benefits Provider (UHC)
Guardian
GEHA
Golden Rule
Lincoln Financial Group
Does our office take HMO plans?
No
What is a TPA?
A third party agreement that allows insurance companies to lease other networks. This provides a larger provider base for patients
How long do you generally have to submit a claim?
1 year
Is whitening generally covered by insurance?
No. Whitening or external bleaching is generally NOT a covered benefit
What is a pre-auth?
A pre-auth or predetermination is a document that allows your insurance company to review your medical necessity prior to treatment
What are some treatments that require a pre-authorization?
Dentures, Crowns, Scaling and root planing
A patient states that they have delta dental. What information should you request from them?
Almost every state has a delta dental insurance company. Delta dental is a trade name. Please obtain the front and back of the insurance card to help locate the specific state
What is an EOB?
An Explanation of Benefits (usually the patient receives a copy first)
What fee schedule does Metlife fall under for Dr. Yee and Ishita?
Connection Dental
DHA is also called what?
DHA or the Dental Health Alliance is also known as Sunlife
