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Is There a Difference Between Preauthorization & Predetermination?

May 16, 2018

Man and woman discussing insurance paperworkThere is, but the specifics of medical coverage preauthorization and predetermination can be complex and frustrating for dental office teams who are already overwhelmed with processing and filing dental benefit claims. If your office provides patients with oral appliance therapy for sleep apnea, you’ll often need to contact a patient’s medical insurance provider to get preauthorization and predetermination to ensure they can receive coverage for the expenses associated with their sleep apnea therapy in your office. The Brady Billing team is happy to answer all of the medical preauthorization and predetermination billing services for our dental offices, so you can place your focus where it belongs – on your patients.

What is a Preauthorization?

Preauthorization is the first step to ensuring your patient has medical insurance coverage that provides payment for sleep apnea therapy. This authorization is simply to tell you whether or not the patient’s policy covers a specific treatment, but it does not tell you how much coverage they have. Once you receive preauthorization, you can then complete request to receive more specific information about their coverage this is the predetermination.

What is a Predetermination?

The predetermination relays the specifics of coverage after preauthorization is complete. A patient’s predetermination from the insurance provider will include necessary information, including what percentage of coverage is available, how the insurer will pay the claim, and when you or your patient will receive repayment. Additionally, predeterminations will usually include information regarding whether or not your patient will receive in-network coverage from the insurer for oral appliance therapy in your office. Once the insurance coverage is authorized, you can usually apply to be considered in-network with your patient’s medical plan for this specific service.

Meet the Brady Billing Team

These are just two of the steps necessary to provide your patients with sleep apnea therapy they need and maximize their medical insurance benefits. At Brady Billing, we are happy to provide a wide range of billing services to make offering your patients medical coverage for sleep apnea therapy a breeze. We know that dental teams are already busy enough with dentistry benefits and the added strain of medical billing seems like it may just be too much. Let the Brady Billing team take this added stress off of your shoulders. Call our team today to discuss the medical billing services we provide and find out more about how we can help make it easy for you to offer oral appliance therapy and help patients maximize their medical insurance benefits.

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