Making a Dental Benefits Claim

Your Plan and the Claims Submission Process

Once your dental appointment is over, it’s time to make your payment and submit your claim. The way you submit your claim and get reimbursed depends on:

• whether the dentist submits it for you;
• whether you assign your benefits to the dentist; 
• or have the plan pay you directly.

Some dentists accept the assignment of benefits. The assignment of benefits means your insurer pays your dentist directly. The dental claim can be submitted to the insurance company by the dental office. All you need to do is provide the dental office staff with your benefit plan number and/or benefits card. Any fees that are not covered by your plan must be paid by you to the dentist.

There are some dentists who do not accept the assignment of benefits; there are some dental plans that will not allow benefits to be assigned. This means that the plan member (you) will be paid by the insurance company. In both cases, this means you’ll need to pay your dental bill upfront. The dental office can still submit the claim electronically to your insurance provider on your behalf and then you wait to get reimbursed.

Getting reimbursed is much faster than it was years ago. Thanks to electronic claims submission, you can see the dentist on Monday and usually get reimbursement before the end of the week. Also, many dentists accept credit cards, which typically have a monthly billing cycle. If you need complex treatment, speak to your dentist about arranging a payment schedule that allows you to budget for expenses.

Benefits of Non-Assignment 

The main benefit of the assignment of benefits is the convenient payment process for patients. However, the ODA opposes the assignment of benefits; instead, we believe that non-assignment of benefits is best.

Why does the ODA oppose something most patients find convenient? Because non-assignment means that patients are more involved in their care and the costs involved.  

By being more involved you can:

• Have a better understanding of your dental plan and can use it wisely.
• Evaluate your dental plan and identify parts that could be improved.
• Develop the confidence to discuss fees with your dentist.

Most dental offices can submit your claim for you electronically as a courtesy. If you need to submit your own dental claim form and need help, your human resources department or your dental plan administrator can assist you.