Understanding the cost of dental care can sometimes be confusing. Many procedures that can be described in simple terms can have multiple costs associated with them. For example, to get a root canal, a patient would likely require multiple x‑rays, a post build-up, a crown and more. For that reason, pre-treatment estimates can help members avoid unexpected surprises.
What is a pre-treatment estimate?
Pre-treatment estimates (also known as pre-determinations or pre-authorizations) are written estimates provided by Delta Dental to members and their dentists. These estimates detail the cost share for a proposed dental treatment and are often requested before complex or expensive procedures, such as crowns, wisdom tooth extractions, bridges, dentures and oral surgery.
Pre-treatment estimates help members understand and manage their costs by breaking down complex procedures into easy-to-understand, itemized lists. They show what portion of a bill is paid by the patient and what portion will be paid by their dental plan.
Pre-treatment estimates are not binding, and factors may change in between requesting the estimate and receiving care that lead to costs being different than expected. For example, coverage may change, an annual maximum may be reached or a member may age out of a procedure with an age limitation. Pre-treatment estimates should be considered an approximation (although a very accurate one!) of the final costs of care.
How can Delta Dental members get pre-treatment estimates?
There are four steps members can take to receive a pre-treatment estimate.
- The Delta Dental member discusses the proposed dental treatment with his or her dentist and asks the dental office to request a pre-treatment estimate from Delta Dental.
- The dental office submits a treatment plan and supporting documentation (such as x‑rays) to Delta Dental for review.
- Delta Dental reviews the documents and the member’s benefits.
- Both the member and dental office receive a copy of the pre-treatment estimate from Delta Dental. This document includes a cost estimate based on the member’s plan type, eligibility, current plan benefits and the amount remaining in their annual maximum.
Pre-treatment estimates are available for members with Delta Dental PPO™, and Delta Dental Premier® and DeltaCare® USA plans. Because DeltaCare USA is a copayment plan, members will have access to a list of copayments for every covered procedure. Pre-treatment estimates may be less useful for DeltaCare USA members than for members with other plans.
Are there other resources Delta Dental offers to help members understand their costs?
Delta Dental members can also use their online account to view their current benefits and benefits usage, as well as to estimate costs. This online cost estimator isn’t as thorough as a personalized pre-treatment estimate, but it can be useful for getting a quick estimate for common procedures.