dso-eligibility

Patient

Select Patient:

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{{memberinfo.memberAddress.postalAddress.city}},{{memberinfo.memberAddress.postalAddress.state}} {{memberinfo.memberAddress.postalAddress.zip5}}

DOB: {{memberinfo.memberProfile.dateOfBirth | date: "MM/dd/yyyy"}}

Spoken Language:

Language Assistance: No

Date of Service:

Insurance Information

In Network

Out of Network

Eligible

Not Eligible

No Essential Health Benefits

Essential Health Benefits

Subscriber ID:

Product ID: {{memberselected.eligibility.product.codeValue}}

Product Type: {{memberselected.eligibility.productPlanType.codeValue}}

Product Line: {{memberselected.eligibility.plan.codeDesc}}

{{(((memberselected.eligibility.fundingType == 'F') || (memberselected.parentGroupIdentifier=='10007' && memberselected.lineOfBusinessId!='0404' && memberselected.lineOfBusinessId!='0138' && memberselected.lineOfBusinessId!='0393') || memberselected.parentGroupIdentifier=='10072' || memberselected.parentGroupIdentifier=='10094' || memberselected.parentGroupIdentifier=='10041' || memberselected.parentGroupIdentifier=='10036') && memberselected.groupState == 'CA') || ((memberselected.parentGroupIdentifier == '10068' && (memberselected.lineOfBusinessId == '0300' || memberselected.lineOfBusinessId == '0394' || memberselected.lineOfBusinessId == '0449')) || (memberselected.parentGroupIdentifier == '10036' && memberselected.lineOfBusinessId == '0200') || ((memberselected.eligibility.fundingType == 'F') && (memberselected.groupState == 'IA'))) ? 'State Regulated' : ''}}

Utilization Search

Fee Schedule

Group ID: {{memberselected.groupId}}

Group Name: {{memberselected.groupName}}

Plan Year Begins: {{memberselected.eligibility.planYearBeginDate}}

Provider Location

Page Access Date:

Address:

{{PprovAddress1}}
{{Pcity}}, {{Pstate}} {{Pzip}}

Submit Claim/PTE

Assignment Status:

Assigned Dentist: {{dhmoMessage}}

Treatment Plan Cost Calculator

Claims Address: UNITED HEALTH CARE DENTAL CLAIMS PO BOX 30567 SALT LAKE CITY, UT 84130-0567

Payor Id: 521337971

Disclaimers

Disclaimer 1: This is the most current information that we have; however, it is the patient’s responsibility to check with the dental provider to verify they are participating and accept the patient’s plan. This is neither an authorization nor a guarantee of eligibility, benefits or payment.

Disclaimer 2: Some ADA codes require dental review guidelines. Predeterminations are highly recommended for procedures over $500.

Disclaimer 3: The information contained is a summary of the patient’s history. Absence of information indicates no history exists for the patient for that category/procedure but does not indicate that there are no limits on the plan.

Disclaimer 4: This document including attachments, may include confidential and/or proprietary information as designated by state or federal law, and may be used only by the person or entity to which it is addressed. If the reader of this document is not the intended recipient or his or her authorized agent, the reader is hereby notified that any dissemination, distribution, or copying of this fax is prohibited. If you have received this document in error, please notify the sender by calling customer service at 1-800-445-9090 and delete this document and its attachments immediately.