Blue Cross / Blue Shield PPO Pre-Authorization
Sunnyvale Dentist Dr. Gupta welcomes you to his practice. After a complete examination and listening to your dental health concerns and goals, Dr. Gupta will present you with one or more treatment plans outlining all possible treatment options.
The staff at Sunnyvale Dental Care has access to the Blue Cross / Blue Shield PPO dental fee schedule, and your breakdown of dental benefits. They will use this information to give you an estimate of your out of pocket dental copay. Some patients request that their treatment plan be submitted to Blue Cross / Blue Shield PPO dental prior to commencing treatment, even though this is not required in most cases. Although this may delay treatment, Sunnyvale Dentist Dr. Gupta is happy to have his front office staff complete this pre-determination or pre-authorization for you.
A pre-determination or pre-authorization will provide a lot of information regarding your individual Blue Cross / Blue Shield PPO dental plan coverage. It will explain your remaining annual benefit amount, the amount of your annual deductible, if your deductible has already been met, whether the prescribed treatment is a covered benefit, what your out of pocket cost will be, and what Blue Cross / Blue Shield PPO dental insurance will pay on your behalf. This information can be very helpful when planning and scheduling your dental appointments. A copy is available for you by mail or online from Blue Cross / Blue Shield PPO dental. A copy will also be sent to us at Sunnyvale Dental Care. Once we receive our copy, we will contact you to answer any questions that you may have and to schedule your next appointment.
Treatment should be scheduled soon after the pre-determination is received because it is valid for a limited length of time. The expiration date will be printed on the form. All approved treatment must be completed while the Blue Cross / Blue Shield PPO dental plan is active. The form will also state that pre-authorizations are not a guarantee of payment. Final payment is determined after the treatment is complete and the claim has been submitted with any required documentation.