Certain services, such as deep sedation, are not covered in all cases. If a provider believes the treatment is medically necessary, they can submit a preauthorization request on behalf of the patient. Approval of the preauthorization request is based on the recommendations of the dental care professional and considers the patient’s dental and medical history.

Services that need preauthorization, including coverage beyond the established frequency limitations, will not be covered under the plan until November 2024. If a service is given without preauthorization, for example, if urgent dental care is required, it may be submitted for post-determination beginning November 2024, with no guarantee that the service will be covered.

Treatments requiring preauthorization are listed below:

  • Specialist dental examination
  • Crowns
  • Posts and cores
  • Moderate sedation, deep sedation and general anesthesia
  • Major surgical procedures
  • Orthodontic services when clinically necessary (starting in 2025)