Claim Pre-Determination Clause Samples

Claim Pre-Determination. If the care member needs costs less than two hundred dollars ($200) or is emergency care, mem- ber’s dentist will proceed with treatment at member’s option. If the cost estimate is more than two hundred dollars ($200) and is not emergency care, member’s dentist will deter- mine what treatment member needs and could submit a treatment plan to dental plan for a pre-determination of benefits. This esti- mate will enable the member to determine in advance how much of the cost will be paid by his/her dental coverage and how much he/she will be responsible for paying.