Preauthorizations

Some dental plans require dentists to receive preauthorization, which is written advance approval for the planned service, before sending claims for certain treatments. Some dental insurance policies may require additional elements for approval, such as diagnostic notes, radiographs, codes, x-rays, periodontal charting, narratives, etc. Otherwise, insurance companies could deny the claims. Although dentists must fulfill an extra step for claim approval, depending on the insurance policy, preauthorizations may guarantee coverage for patients.

Why are preauthorizations needed?

Some insurance companies require preauthorizations for a variety of reasons. They allow dental plans to check whether the procedures are medically necessary and may recommend other treatments and services. Some treatments that require preauthorization include those categorized as major, such as extractions, periodontal surgery, and root canals.

Melissa Dunham, of Reign Dental Accounts Control LLC and the Centre for Dental Excellence in Virginia Beach, recommends “that all treatment plans, excluding prophies, perio maintenance, and films, should be preauthorized for the protection of the office income and to assist patients in making informed financial decisions regarding treatment.” Without this, the patient loses coverage, regardless of whether the procedure is an included benefit in his or her policy.

More claim approval

Preauthorizations may help patients receive coverage, depending on the policy and state. Not all health plans provide coverage after giving preauthorization to dentists, but in states such as California, they must provide coverage for any preauthorized treatments. Due to these state laws, many insurance companies omit preauthorization requirements from their policies. Plans that do require them usually include Medicare, Medicaid, and managed care plans.

Despite preauthorization, dental plans may not provide coverage in cases where the beneficiary leaves the plan before the treatment date, the beneficiary runs out of his or her annual maximum limit, or other factors such as subsequent claims for the same procedure from a different provider. Despite these caveats, they can still predict coverage and the patient’s financial responsibility. They can also include information regarding plan limitations, patient out-of-pocket costs, downgrades, exclusions, and more.

Preauthorizations could lead to more approved and reimbursed claims, increased treatment plan acceptance, and more guaranteed payments. Even though many insurance companies may not need preauthorizations anymore, preauthorizations can still help patients gain coverage in order to access and pay for any necessary dental treatments and services.

If you are struggling with preauthorizations, consider partnering with eAssist. Our Success Consultants will ensure your claims are always billed correctly. To learn more, schedule a consultation.

Sandy Odle

Co-Founder and CXO, eAssist

Sandy Odle is the Co-Founder and CXO of eAssist Dental Solutions, where she has played a key role in shaping the company’s business and marketing strategies, leading to record growth and national recognition on the Inc. 500 and Utah Top 100 lists. A passionate social entrepreneur, Sandy believes that business is about building meaningful connections and creating personalized solutions that truly meet customer needs. Her relentless commitment to delivering exceptional client experiences is at the heart of eAssist’s mission. Drawing on the discipline and attention to detail honed during her early career as a ballet dancer, Sandy brings a unique blend of creativity, precision, and work ethic to everything she does.