Maybe you or your child’s wisdom teeth need to be removed? Certain dental services may be covered by HUSKY Health or Covered CT, but they require “Prior Authorization.”
Prior Authorization is the process of ensuring that the treatment proposed by a dentist is a HUSKY Health covered dental service that is necessary and meets dental standards of care. A Prior Authorization request may be approved, approved with a copay (HUSKY B), pended for additional information, or denied.
Why Prior Authorization?
Why do some dental services require Prior Authorization?
Prior Authorization is used to ensure that we are adhering to the Medicaid policies and that the service requested is appropriate.
What Services Require It?
What are some typical services that require Prior Authorization?
Some common services that require Prior Authorization include orthodontia for pediatric members, dentures, mouth guards, root canals and crowns.
Will I be notified if my Prior Authorization is approved?
Your dentist will receive a notice once the Prior Authorization request has been reviewed. Your dentist should let you know if the service has been approved. And coming soon, you may be able to view approvals in the secure member area of our website. Be sure you register for this access.
What if Declined?
What do I do if my Prior Authorization is declined?
If your Prior Authorization is denied, you can appeal the decision by returning the appeal form that you will receive with your denial letter. A different reviewer will look at the prior authorization request. Instructions on how to appeal a denial are included with the letter you receive.
Not a Guarantee
Lastly, it is important to note that Prior Authorization is not a guarantee that HUSKY Health will pay for approved dental services. Dental benefits used before the approved services are completed may reduce available benefits. If you lose eligibility before approved dental services are completed they will no longer be covered.
If you have any additional questions regarding Prior Authorization, be sure to call our friendly representatives on our Member Services line at 855-CT-DENTAL (855-283-3682).