…and Why Coordination of Benefits Matters
At Gregorin Dental, we understand that dental insurance can be complicated, particularly when it comes to claim processing, dual coverage, or waiting for predeterminations. Our goal is to make things simple and transparent, so you always understand what’s happening behind the scenes and how to avoid unnecessary delays or unexpected bills.
Here’s what you should know about how dental claims are processed and why keeping your insurance information up to date is so important
Step-by-Step: How Dental Claims Are Processed
- Your Visit: After your appointment, we document the services provided and collect any copays or estimated out-of-pocket costs.
- Claim Submission: Our office submits a detailed insurance claim electronically (or by mail) to your dental insurance provider. This includes procedure codes, tooth numbers, and any necessary X-rays or clinical notes.
- Insurance Review: The insurance company reviews your claim according to your plan’s coverage, waiting periods, and frequency limits.
- Payment or Explanation of Benefits (EOB): Once processed, the insurance company sends an Explanation of Benefits (EOB) outlining what was covered, what was applied to your deductible, and what portion is your responsibility.
- Patient Balance: If there’s a remaining balance after insurance pays its portion, we’ll send you a statement for that amount.
What If You Have Two Dental Insurance Plans?
Many patients are double-covered, meaning they have two dental insurance plans (for example, through their own employer and their spouse’s employer). When you’re double covered, one plan is considered your primary insurance, and the other is secondary. These two plans work together to pay for your care, but only if both companies are aware of the other’s coverage. That’s where Coordination of Benefits (COB) comes in.
Why Coordination of Benefits (COB) Is So Important
Coordination of Benefits ensures both insurance companies know which plan should bе billed first. Without this coordination, insurance companies often pause or deny claims until they receive the necessary COB information.
This can lead to:
- Processing delays – claims can take weeks (or months) longer to process.
- Missed timely filing deadlines -most insurance companies require claims to be submitted within a set period (often 6–12 months after treatment).
- Patient responsibility – if claims are delayed or denied due to missing CОВ information, patients may become responsible for the full cost of services.
Tip: Always keep both insurance companies informed if you have dual coverage. If your employer, spouse, or policy changes, please notify our office immediately so we can update your file and help prevent claim delays.
How Long Does a Dental Claim Take to Process?
Most electronic dental claims are processed within 2 to 4 weeks, depending on the insurance company. However, if additional information is requested (like X-rays, narratives, or proof of coordination of benefits), it can take longer. That’s why submitting accurate, complete information from the start is key to faster payment and fewer headaches later.
What Is a Predetermination – and How Long Does It Take?
A predetermination (sometimes called a pre-authorization or pre-estimate) is a request we send to your insurance company before treatment begins to find out what your plan will cover. This is especially useful for major services, such as crowns, root canals, or dentures.
- Processing time: Most insurance companies take 2 to 6 weeks to review and return a predetermination.
- Once received, the insurance company sends an estimate of how much they’ll pay and what portion will be your responsibility.
While a predetermination isn’t a guarantee of payment, it provides a clear idea of what to expect, helping you plan your care and budget with confidence.
Avoid Delays: How You Can Help
To ensure smooth and timely claim processing, please:
- Provide updated insurance information at each visit.
- Notify us immediately of any changes in coverage or if you have dual insurance.
- Respond quickly if your insurance company contacts you for additional details.
Working together helps us keep your claims on track – and prevents unnecessary out-of-pocket costs or delays.
We’re Here to Help
Our team at Gregorin Dental is always happy to help you understand your insurance coverage, coordinate benefits, and track your claims.
If you have questions about your dental plan, need help updating your insurance information, or want to check the status of a claim or predetermination, please call us at (907) 333-5522; we’re here to make the process simple and stress-free.
