The pathway for dental claims can be complicated and intricate. Wondering what happens to your claim after you pay for a dental treatment? Take a peek behind the curtain:
- At the time of service, the dental office staff will usually ask you to pay your estimated portion.
- The clerk submits the claim electronically.
- The claim is first “scrubbed” by an electronic clearinghouse, then sent to your insurance provider (in this case, Delta Dental) to be read.
- Delta Dental’s software looks into your level of coverage and any applicable copay.
- If your claim needs to be reviewed by a person, it will be placed in a specified batch for a treatment plan analyst to review.
- When benefits and copays have been determined, the claim becomes a remittance advice document and is sent to your dental office.
- With the remittance, the dental office will bill you for what is owed above what you already paid on your day of treatment, if anything.
- For most claims, that’s the end of the line!
Want to learn more about your dental insurance? Check out our Dental Insurance 101 webpage.