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If you must send the original and need it returned to you, please clearly indicate your wishes on the x-ray and claim form.Q: Am I required to submit a predetermination of benefits before beginning treatment on a patient?Q: Do I have to take a write-off on a procedure that isn’t covered by the patient’s dental plan?
Q: Can I bill the patient the difference between my fee and your allowance?
A: When you participate with Delta Dental, if your fee for a service exceeds Delta Dental's maximum plan allowance, participating dentists agree to write-off any difference and not charge the remaining balance to the patient. A: We recommend that you apply your normal billing procedures to all patients - "bill all on prep date or bill all on delivery.” (Excludes partials or dentures, which must be billed on seat date).
While third-party claim submission policy offers dentists some latitude as to whether claims may be submitted at the commencement of procedures or at their conclusion, no ethical principle allows a dentist to bill and retain money for work that is not performed (ADA Ethics).
Submitting a monthly claim for orthodontics is not necessary.
Normally, the claim is filed for the entire treatment, and Delta Dental automatically makes a payment each month until the treatment is completed, terminated, or the patient is no longer eligible.
Predeterminations allow your patient the opportunity to make proper financial arrangements for their portion of the treatment cost before actual work begins.