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Pre-determination letters are submitted on the provider's letterhead. The letter requests advance verification that the patient is covered for the medical service. Failure to submit a pre-certification letter usually results in denial of the claim for payment.
The main difference between a predetermination and a preauthorization is that the predetermination provides a confirmation that the patient is a covered enrollee of the dental plan and that the treatment planned for the patient is a covered benefit.
Feb 28, 2020. \ufeffA predetermination of benefits is a written estimate from your dental insurer of the amount your dental plan will pay for a specific treatment based on information provided by your dentist. SDC's predetermination process is helpful for both the patient and the treating dentist.
A predetermination of benefits is a review by your insurer's medical staff. They decide if they agree that the treatment is right for your health needs. Predeterminations are done before you get care, so you will know early if it is covered by your health insurance plan.
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