Patients are recommended to seek a predetermination
of payment from United Concordia for all complex dental treatment plans. To submit the predetermination
request, complete a
TDP OCONUS
Claim Form and include a statement from the host nation dentist identifying the total cost of all
treatment needed. United Concordia will review and provide the patient with a summary of the covered costs.
There is a maximum benefit of $1,200 per contract year per patient. The contract year is Aug. 1,
2011 - April 30, 2012.
Follow the simple steps below to request a predetermination from United Concordia:
1
Submit a Claim Form to United Concordia
On the TDP OCONUS Claim Form, check the box on top of the form next to “Dentist’s Pre-Treatment Estimate.” Be sure to include a description of the treatment requested. No dates of service should be reported.
2
United Concordia Notifies You and Your Dentist
United Concordia will notify both you and your host nation dentist via the "Dental Predetermination Notification and Request for Payment Form" that your predetermination is finalized. Please
note: A predetermination is not a guarantee of payment. Rather, it indicates how much is payable based on the information at the time the predetermination request is made.
3
Return the Predetermination for Processing
After you receive the treatment, return the "Dental Predetermination Notification
and Request for Payment Form" to United Concordia indicating the dates the
services were provided. If multiple services have been predetermined, it is not
necessary to have all services performed in order for the predetermination
notification to be returned for processing.
After receiving the predetermination, the sponsor may submit the second
Non-Availability Referral Form (NARF) approving the implant services,
the TDP OCONUS Claim Form, and the dentist's bill for full implant services
to United Concordia for payment.
