What is a pre-determination?
A pre-determination is best described as a "pre-claim". Basically the provider submits the dental services as if they were doing a standard claim submission. They would include the service and diagnosis codes. Once received by Humana, we will determine dental necessity, as well as give an estimate of how much your potential out of pocket expenses will be, dependent on your dental policy.
These usually take 30 days to process, so it is encouraged to have your provider submit right away. We usually suggest have a pre-determination submitted for dental services that are expected to be over $300.00.
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