Official Careington Benefit Solutions

Frequently Asked Questions

Q: What's the status of my claim?

A: Claim status can be found under "My Plan/Claim Status".

Q: How do I appeal a claim?

A: Appeal must be submitted in writing via email to [email protected].

Q: When can checks be tracked/reissued?

A: A check cannot be voided and reissued until 90 days after the check issue date.

Q: Why is a claim paid to the member instead of the provider?

A: Box 37 on the claim form assigns benefits to the provider or the member. When a signature is present in this box, the benefits (payment) is sent to the providers office. When left blank, the benefits (payment) is assigned to the patient.

Q: How long are predeterminations good for?

A: Your plan does not require that services be preauthorized, but it's always a good idea to get a pre-treatment estimate for high-dollar services. These estimates are good for 60 days, but not longer than the contract's term or beyond the date the patient's coverage ends. This is an estimate and not a guarantee of payment. These can be found on the portal under "My Plan/Claim Status".

Q: What is the difference between in-network and out-of-network dentists?

A: An in-network dentist has a contractual agreement to provide dental care to members at prenegotiated rates. Visiting an in-network dentist can save you money off of standard rates for dental services. An added benefit of using an in-network dentist is you won't need to submit any claim forms. The in-network dentist submits all dental claim forms directly to us on your behalf.

Members who visit an in-network dentist will not be charged more than the contracted rate even when the dentist's normal rate is higher. Note that an out-of-network dentist may charge their regular rates for services, but we will only pay a standard amount. You will be responsible for the difference.

Q: What do the terms deductible and annual maximum mean?

A: A deductible is the dollar amount that you're responsible for paying before the insurance plan will start to pay benefits.

An annual maximum is the maximum amount your plan will cover each benefit year.

Q: How long will it take for my Dental claim to be processed?

A: Once a dental claim has been received, the turnaround time is approximately 15 business days

Q: What is a waiting period?

A: A waiting period is the time period following your coverage start date during which no benefits are paid.