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| DENTAL |
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| Predetermination
of Benefits |
Predetermination of Benefits is a voluntary review
of a Dentist's proposed treatment plan and expected charges. It is not
preauthorization of services and is not required.
The treatment plan should include supporting preoperative
x-rays and other diagnostic materials as requested by Cigna's dental
consultant. If there is a change in the treatment plan, a revised plan
should be submitted.
Cigna will determine covered dental expenses for the
proposed treatment plan. If there is no Predetermination of Benefits,
Cigna will determine covered dental expenses when it receives a claim.
Review of proposed treatment is advised whenever extensive
dental work is recommended (when charges exceed $200).
Predetermination of Benefits is not a guarantee of
a set payment. Payment is based on the services that are actually delivered
and the coverage in force at the time services are completed.
CIGNA does not have a specific form for pre-treatment
(or Predetermination of Benefits) for Dental services. Covered individuals
should utilize the claim
form and the box in Section 1 should be marked accordingly.
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