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.