Navigating dental implant procedures can be complex, especially when it comes to leveraging your coverage effectively. For Boeing members enrolled in the BCBSIL Traditional Medical Plan, here's a comprehensive tip sheet to guide you through the process seamlessly.
Step 1: Get a Predetermination
Before embarking on your dental implant journey, dental provides should initiate the process by submitting a predetermination to Delta Dental of Washington. This involves the surgical placement of the implant post and the attachment of the implant crown or denture. Delta Dental of WA will provide valuable insights into the coverage options available through your dental plan.
Step 2: Notify Your Patient About Medical Coverage
Notify your patient regarding their potential medical coverage. Communication with your patient will help the process move more seamlessly. Ensure you have a copy of their medical insurance card, so you can verify benefits.
Step 3: Claim Filing Process
Understanding the claim filing process is crucial to maximizing your benefits. Depending on your coverage, follow the outlined steps:
Dental Plan Has Implant Coverage:
- Dental Plan Covers: Abutments, surgical placement of the implant post, implant crown, or denture.
- The dental plan is the primary payer, and the medical plan is secondary.
- Submit a claim to Delta Dental for the surgical placement of the implant post.
- Once you receive your Explanation of Benefits (EOB) from Delta Dental, submit the implant claim to the medical carrier. Include a copy of the dental EOB and medical ID card, using dental claim forms and procedure codes.
- The medical carrier will coordinate benefits with Delta Dental.
Dental Plan Has NO Implant Coverage:
- Dental Plan Covers: Implant crown or denture.
- Medical Plan Covers: Abutments and the surgical placement of the implant post.
- Follow the same process as above, with Delta Dental handling the claim for the surgical placement of the implant post.
Dental Plan Does Not Cover Abutments and Surgical Placement:
- Dental Plan Does Not Cover: Abutments and the surgical placement of the implant post, implant crown, or denture.
- Medical Plan Covers: Abutments and the surgical placement of the implant post.
- Similar to the above scenarios, initiate the claim with Delta Dental for the surgical placement of the implant post.
Understanding and utilizing the coverage options is key to maximizing the abutment and implant benefits. By following these steps, Boeing members with BCBSIL Traditional Medical Plan can ensure they make the most of their benefits.
Commentaires