When submitting a dental claim, the right documents make all the difference. Whether it’s an invoice for completed treatment or a cost plan for an upcoming procedure, having a clear breakdown helps us process your claim quickly and accurately.
What is an itemized invoice for dental treatment?
An itemized invoice is a detailed bill provided by your dentist that includes a breakdown of all procedures performed during your dental visit. It lists the fee number for each treatment according to the official dentist fee schedule (GOZ or BEMA code), the cost of each procedure, the date of the treatment, the total charge, and any contribution from your public health insurance provider if applicable. You must submit all pages of this invoice because sometimes the procedure breakdown appears on subsequent pages. Without the full invoice, we cannot process your claim.
What is a cost plan and when do I need to submit it?
A cost plan is a treatment estimate your dentist provides before starting certain procedures, especially more complex ones such as implants, crowns, or other restorative work. This estimate helps us review and pre-approve coverage for your planned treatments. You do not need to submit a cost plan for standard dental work like cleanings or fillings. For complex treatments, submitting the cost plan before starting the procedure is strongly recommended.
What details must be included in a cost plan or treatment agreement?
The cost plan or treatment agreement should contain a detailed breakdown of the planned treatments, the fee number for each item according to the fee schedule (GOZ/BEMA), the estimated cost for each treatment, the total estimated cost, and any contribution from your public health insurance if applicable. For complex procedures, the cost plan often includes separate pages showing material and laboratory costs from the dental office or third-party labs. Make sure to submit all pages of the cost plan, as a summary page alone is insufficient.
Why is submitting complete itemized invoices and cost plans important?
Submitting complete and detailed documentation allows us to verify the treatment details and costs accurately. This helps avoid claim processing delays or the possibility of claim rejection. Providing all pages of invoices and cost plans ensures we can support your claim efficiently and thoroughly.