Understanding your dental claims
To get started, view your plan details and claim information online
Knowing what is covered by your policy is the first step toward understanding what happens with your claim. How much does my plan pay? How much do I pay? You can view this information and more in My Dental Benefits:
- What services are covered under your plan
- How much your plan will pay for each service
- The status of your claim
- Explanations of Benefits (EOBs) for claims
- Procedures you’ve received in the past
- Find a dentist in your network
How much can a dentist charge you?
Dentists who participate in your network have agreed to accept negotiated fees (or maximum allowable charges) as payments in full for covered services.
That’s the big difference between network and non-network dentists. Network dentists can’t bill you for the difference between their standard charges and our negotiated fees, and non-network dentists can. Both will charge you for applicable deductibles and coinsurances.
Do you have to file a claim for each dental visit?
It depends. Network dentists will file claims on your behalf. A non-network dentist may ask you to complete and submit your own claims.
Is it easy to check claim status?
Couldn’t be simpler. Just sign in to My Dental Benefits. Select the member’s name; then click Claim Information to the left. You can check claims by specific date or date-range.
What is an Explanation of Benefits (EOB)?
An explanation of Benefits (EOB) is a statement that shows the services you received and from which dentist, how much your plan paid for that service, and how much you are responsible to pay. See more details on reading an EOB.
Where do I go with claims questions?
Just contact us and one of our representatives will be happy to help.
Why you can’t get your child’s or spouse’s claim information
Due to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), United Concordia is only permitted to share information regarding your own claims and any dependents under the age of 18. This includes spouses.
We take our members’ privacy seriously. With your dependent or spouse’s written permission, we can release information to specified individuals over the phone. Without this permission, dependents age 18 and older will need to contact us to get their own information from customer service.