Presupuestos previos al tratamiento

Use Provider Tools to avoid surprises with a free, real-time pre-treatment estimate.

Before you start treatment, log in to your online account and use the Submit Claim or My Patients tools to request a pre-treatment estimate. Pre-treatment estimates often process within moments (when clinical review isn't required), so you can talk with your patients about treatment plans while they are still in your office. Pre-treatment estimates tell you about:

  • las limitaciones contractuales o exclusiones que se aplican a su plan de tratamiento
  • Delta Dental’s estimated payment amount
  • The patient’s estimated payment portion

Ventajas

  • Determine how best to plan treatment; for example, treatment may be done in segments, over weeks, months or years, to incorporate all available benefits
  • Develop a payment plan for the patient, taking into account what Delta Dental is expected to pay
  • Receive email notifications when new documents are available to review online (when you sign up to discontinue paper documents).

Cuándo solicitar un presupuesto previo al tratamiento

  • Expensive or extensive treatment is being considered
  • Dental plan annual maximum, limitations and/or exclusions may affect coverage

How to Request a Real-Time Pre-Treatment Estimate

Log in to (or register for) your Online Services account.

From the Provider Tools screen, select the My Patients tool or the Submit Claim tool.

To use My Patients:

  • First, select the patient. Then, select the Submit Claim icon under Actions.
  • Next, under Type of Transaction, choose Pre-Treatment Estimate.
  • Complete the claim information, click Continue, then Submit Claim.

To use Submit Claim:

  • Enter your patient’s name and choose Existing (or enter a new patient’s information).
  • Select the patient, then select the Submit Claim icon under Actions.
  • Next, under Type of Transaction, choose Pre-Treatment Estimate.
  • Complete the claim information, click Continue, then Submit Claim.

Use the My Claims tool to see Delta Dental’s estimated payment and the patient’s portion (often within moments when clinical review is not necessary).

Or, you may mail a paper claim to Delta Dental. Incluya todas las radiografías, la documentación o los informes por escrito. Recibirá por correo un presupuesto previo al tratamiento que indicará el monto que Delta Dental debe pagar y el monto que el paciente debe pagar. Unfortunately, we cannot provide pre-treatment estimates by telephone.

Limitaciones

Keep in mind, a pre-treatment estimate is not a guarantee of payment and it does not check the patient’s:

  • Eligibility (until the date of service)
  • niveles de incentivos
  • valores máximos o deducibles
  • Any additional coverage that may apply

At any time, you can review the patient's current eligibility and benefits information, including remaining maximum and deductible amounts. Simply log in to your Online Services account (or register if you have not already done so) and use the Eligibility and Benefits tool.

Cuando se finalizan los servicios y se recibe una reclamación de pago, Delta Dental calculará su pago según la elegibilidad actual del afiliado, el monto restante de su límite máximo anual y los requisitos de deducible.

How to Submit a Claim for Payment

When the services are completed, log in to Online Services and use the My Patients tool or the Submit Claim tool to transmit a new free, real-time claim for payment.

Or, transmit a claim via a clearinghouse, or complete and mail a paper claim to the Delta Dental company through which the patient has coverage.

  • Solo incluya en la reclamación los servicios brindados (no incluya los servicios no brindados aun si estaban incluidos en el presupuesto previo al tratamiento original).
  • Incluya además todos los servicios adicionales brindados.
  • Envíe la reclamación a Delta Dental lo más rápido posible una vez que los servicios se completen (en todos los casos, las reclamaciones deben presentarse antes de los seis meses de la fecha en que se brindó el servicio).

Nosotros procesaremos la nueva reclamación de pago usando la elegibilidad y las disposiciones de beneficios actuales.