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Request for additional information for determination of benefits for GEHA

February 25, 2026 by Sarah

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  • Request for additional information for determination of benefits for GEHA

Request for additional information for determination of benefits for GEHA

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We have received a letter from GEHA asking for additional information for the determination of benefits and one of the questions was when the banding date was. At this time, we haven’t begun treatment yet since patient was wanting to know the determination of benefits before beginning treatment. What should be entered for that question? Thank you!

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Posted by Sarah
Asked on February 25, 2026 3:20 pm
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Hello! I would recommend calling GEHA and letting them know that there is no banding date scheduled yet, as the patient would like to wait to begin tx until they receive an insurance estimate, hence your office submitting the pre-auth, so the patient can determine their estimated financial responsibility prior to beginning orthodontic tx. When speaking with GEHA, you can let them know that the proposed ortho tx duration is approximately (XX months), and the patient will be seen every (x weeks/months) for adjustment visits, per the treatment plan. I would recommend clarifying again that the banding date is currently TBD, pending GEHA's insurance determination and the pt's decision to proceed. I would also recommend submitting a letter of medical necessity from the provider outlining the treatment plan if you have not submitted this already :)

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Posted by Austinida
Answered on February 26, 2026 6:02 am
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