If your dental claim has been declined for either yourself or one of your eligible dependents, you have choices:
Why was it declined? Every decline has a reason. The decline letter, also referred to as an Explanation of Benefits (EOB), will list the decline code at the bottom. If you don't have an EOB, you can call your insurance company directly, or ask your dentist's office for the reason why.
What are the most common reasons for a decline?
If your dental claim was declined, it was most likely due to one of these reasons:
Incorrect information: If there is a mis-match between your name, date of birth, and policy numbers between what your dentist has on file, and what the insurer has, that could lead to a decline due to identity. Solution: Make sure your address, policy numbers, and full legal name is up-to-date with your dentist and insurer. You can email service@beneplan.ca to update your file with the insurer.
Maximum reached: Your benefit plan likely has a maximum dollar amount that you can spend per year, and it may have been reached.
Service code not covered: Your plan covers many codes, but not every possible dental service or product. For example, cosmetic treatments are typically not covered. Check your policy or call your insurer to find out what your particular plan does and does not cover.
Co-insurance / deductible / co-pay: If your claim was partially paid, and you have to pay a certain amount, that means your plan may have co-insurance, also known as a co-pay or deductible. This means your plan requires you to share in the cost of the plan.
Coverage terminated: If your plan has terminated due to you leaving your firm, the benefits will also expire as of either your last day worked, or a day extended past your last day at work depending upon your circumstances. Please speak to your plan administrator or employer if you have questions.
Dependent not listed: If it's the first time you're submitting claims for a dependent spouse or child, and you haven't enrolled them in the plan yet, please contact your plan administrator or email service@beneplan.ca for assistance.