A claim is a request from a provider, like a dentist, to an insurance provider for compensation from a patient visit. An employee may be required to pay a portion of the claim in the form of a deductible, coinsurance, or copay.
- Claims can be classified as preventive, basic, major or orthodontic, and these may be covered at different rates according to your specific plan.
- Employees can ask their dentist to get a pre-treatment estimate before their visit. This will help them understand their out of pocket costs before the visit.
How it works
- Chris receives a preventive cleaning by their in-network dentist.
- After the cleaning, the dentist files a claim with Chris' benefits provider to request payment.
- The benefits provider covers the full cost of the preventive service claim. Chris pays nothing.