PRE-AUTHORIZATION

Pre-authorization or prior authorization is the process of pre-determining patient coverage and approval of treatment plan from insurance provider before the treatment is performed by the dentist with the hope of claim getting paid.

Expensive dental services such as root canal, dental implants, laser whitening, etc. require pre-authorization. It not only minimizes the chances of denial but also saves time and money for both the patient and Dentist.

Pre-authorization helps dentists determine a patient’s coverage hence making it easier for any dental office to figure out the payment procedure.

Few Reasons Behind The Claim Denial Even After Pre-Authorization:

  • The patient is not eligible anymore
  • The patient has maxed out the allowable
  • Time limit exceeded
  • Other insurance primary
  • The wrong provider provided services

According to the American Dental Association Council, all dental benefits programs (if possible) should empower patients by providing paper copies (or website) of benefit booklets & policy guidelines which helps them in decision making.

State laws are responsible for making sure the employee benefit booklets and disclosures must be written at a grade school reading level and even in national languages other than English to help patients understand it in a better way. 

Problems might occur if there’s a year gap between the pre-authorization and the treatment. The explanation and engagement by the dentists vary from product to product. Usually, dentists have access to a booklet/catalogue or a website that lists all necessary details about the insurance cover, benefits, payment obligations, etc. 

Benefits Of Pre-Authorization

  • Saves time & money.
  • Quicker turnaround.
  • Can be used to uncover proposed treatment which is not covered or is not allowed.