By Human Resources Communications on April 23, 2019
Under the UBC Extended Health plan, claims for medical equipment costing $5,000 or more require preauthorization prior to purchase.1 Under the UBC Dental Plan, any major treatment of $500 or more requires a predetermination prior to the treatment.2
However, if you find a recommended treatment plan or medical device to be cost-prohibitive, Sun Life will provide you with a preauthorization or predetermination free of charge.
Sun Life will first determine whether coverage is available to you, and if so, how much of the cost will be covered by your UBC Extended Health or Dental plan. This information will help you determine whether to move forward with the recommended treatment or purchase and could also be helpful if you decide to speak to your provider about an alternative treatment.
How do I request a medical services and equipment preauthorization or a dental predetermination?
Medical Services & Equipment Preauthorization
- Complete the appropriate Extended Health Plan Claim Form for your employee group, indicating “Preauthorization” on the form.
- For medical equipment and supplies, please make sure that the estimate includes the following information:
- Date of purchase
- Claimant’s name
- Item description, including make and model name if available
- Physician’s name
- Proof of the portion paid by the province in which the service or medical equipment was obtained (if applicable)
- Receipts must be legible and each expense must be listed separately and clearly indicated.
- Cash register receipts are acceptable if the name of the product is included, a physician’s referral is attached, and/or the name of the patient is indicated on a signed claim form.
- If the receipt is for a brace, please indicate the body part (e.g. left knee brace).
- Attach the recommendation from your physician (if required).
- Make copies of all the above and mail to the nearest Sun Life Claim Centre as indicated on page 2 of the claim form, or submit the estimate using the “send documents” feature on the Sun Life Mobile app.
Many dental offices will electronically submit predetermination requests to Sun Life on your behalf. If your dental office prefers to submit predetermination requests on paper, have the dental office:
- Complete the appropriate Dental Plan Claim Form for your employee group, indicating “Predetermination” on the form.
- Ensure any x-rays or models are included with the request, if applicable.
- Have the dental office send this request to the nearest Sun Life Claim Centre as indicated on page 2 of the claim form.
Once Sun Life has reviewed the claim, they will mail a Claimant Statement to your home address. If you have registered for access to the Sun Life Plan Members’ website, you will be notified that the Claimant Statement is available for download.
1 Preauthorization is required and it is a request for preapproval for reimbursement of medical services and equipment under the Extended Health benefits plan.
2 Predetermination is recommended and it is a fee estimate submitted to Sun Life. Sun Life will advise you and your dentist what portion of the fees will be reimbursed under the Dental plan.
Do you have questions? Contact the Health, Wellbeing & Benefits team at firstname.lastname@example.org.
By Human Resources Communications on February 20, 2018
Understanding dental charges and claims doesn’t have to be like learning a foreign language. In this article, we demystify dentist fees and dental claims – all to help you become more informed.
What is the Dental Fee Guide?
The British Columbia Dental Association (BCDA) produces an annual fee guide¹ for BC dentists, outlining over 1,400 dental codes, code descriptors and suggested fees that relate to specific elements of dental treatment. The document serves as a guide only: dentists are not required to follow the guide or any fee schedule.
Many dental plan providers base their coverage on the fees and codes within this guide. Sun Life, UBC’s Dental Plan provider, reimburses for dental services based on the current year’s BCDA fee guide for general practitioners.
How do dentists determine their fees?
The cost of delivering high-quality dental care is based on the complexity of treatment for each patient, as well as the cost of the following factors²:
- Specialized equipment
- Approved materials
- Sterilization and safety protocols
- Trained and licensed professional staff
- External laboratory fees
- Location of dental practice
What about fees for dental specialists?
Dental specialists receive additional training in a particular field of dentistry. When a high level of expertise is required, general practice dentists will refer patients to a specialist.
Treatment provided within speciality fields is often highly technical and complex. It can involve the use of special equipment, specific materials for treatment, additional staffing and ongoing education. All these factors are considered by specialists when determining treatment costs.
How can I be more informed?
1. Talk to your dentist.
Discuss all of your treatment options and the associated costs with your dentist before proceeding with treatment. Read on to learn what you need to do for recommended dental care procedures in excess of $500.
2. Ask if your dental office follows the BCDA fee guide.
A dental office may bill some, or all, codes based on the suggested fee guide.
UBC’s Dental Plan reimburses based on the current year’s BCDA fee guide for general practitioners. If your dental office charges more than the guide, you will be responsible for the additional cost.
If you receive dental services from a dental specialist, Sun Life reimburses based on the BCDA fee guide for general practitioners, plus 10%. You are responsible for any amounts not covered by the UBC Dental Plan.
3. Get a preauthorization for recommended dental work prior to receiving treatment.
For dental care procedure(s) in excess of $500 and all orthodontic work, you must receive a preauthorization from Sun Life before you obtain treatment.³
To begin the process:
- Ask your dentist to complete the Dental Claim form, detailing the dental procedure(s) or orthodontic treatment plan. Your dentist can send this form to Sun Life for you, either by mail or electronically.
- Your dentist should include supporting information (e.g. x-rays or pictures of models or molds) to illustrate the services that are being recommended. If your dentist doesn’t provide this information, your preauthorization for services will be declined until this information has been received and reviewed by Sun Life. Sun Life may also request further information from your dentist as part of its review process.
- Once the review process is complete, Sun Life will send you a Claims Statement outlining what part of the cost is covered by the plan and what you will have to pay.
How do I make a dental claim?
Many dental offices will submit claims for your dental procedure(s) directly to Sun Life. You’ll need to provide your dentist with your UBC Group Number (025205) and your Member ID (seven-digit UBC employee number).
For more information about dental reimbursements when your dentist submits a claim on your behalf, click here.
If your dentist does not submit claims on your behalf, you can submit a claim yourself.
¹ The BCDA does not produce an electronic version of the fee guide for the public or its members. Instead, you can find a print copy at BC public libraries – the same version sent to all dentists in BC. If patients have questions about a specific code, they can ask their dentist directly, or contact the BCDA at 604-736-7202.
² Dentists are governed by the Health Professions Act of BC. Like medical clinics, dental clinics must adhere to strict regulatory standards to ensure a high level of patient safety and care.
³ It is your responsibility to request a preauthorization before receiving dental treatment in order to know what the dental plan will cover and how much you will be expected to pay out of pocket. If you obtain dental services without a preauthorization, you are responsible for what the plan does not cover. In the case of major dental work or services provided by a dental specialist, this could be a significant and unexpected amount.