Dental Predetermination

You should discuss any proposed basic or major restorative treatments with your dentist to understand both the cost of the treatment and to determine if a proposed treatment plan (dental predetermination) is needed. To avoid surprise out-of-pocket expenses, we recommend having your dentist submit a dental predetermination in advance of any proposed treatment, especially if the cost is $800 or more.
On occasion, ASEBP may request pre-treatment X-rays or other information from your dentist to support a treatment plan. Where two or more courses of treatment are submitted, reimbursement will be based on the least expensive of the proposed treatments.

Here are some important things for you to know:

  • You can find your dental predeterminations online on My ASEBP under Documents.
  • Receiving a predetermination isn’t a pre-approval for the reimbursement of your expenses. It’s a confirmation that the prescribed treatment you’re considering is included as part of your ASEBP coverage.
  • Predeterminations only take into account the costs that have been accumulated against your maximum at the time of the authorization—they don’t include any costs that haven’t yet been billed to ASEBP or coordination of benefit rules, etc.
  • To be reimbursed for the amounts confirmed, you or your dependants must start the treatment within 90 days of your dentist submitting the predetermination to ASEBP. If your treatment began prior to you receiving ASEBP coverage, please submit a predetermination with the start date of your current treatment plan. Note that treatments incurred prior to your effective date of coverage won’t be eligible for reimbursement.
  • Depending on the cost of your proposed treatment plan (whether it’s above or below $800) as well as how your dental provider submits the predetermination (e.g. mail or electronically), you may or may not receive your own copy of the predetermination. If you don’t receive a copy and would like to review the predetermination and how much your ASEBP Dental Care benefits will cover, please speak with your dental provider as they’ll receive confirmation of payment coverage breakdowns for all submitted predeterminations.
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