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Dental Plan FAQ's

Specialist Provider Questions

  1. Do I need a referral to see the patient?
  2. How do I know if a patient has the Specialty Benefit Amendment?
  3. How do I get reimbursed for services?
  4. What is the Specialty Benefit Amendment (SBA)?
  5. Do all patients have the SBA?
  6. How can I receive information about the SBA if I don't currently accept members with the SBA?
  7. If I do not wish to accept members with the SBA, what should I do?
  8. Where do I submit an SBA claim for the remaining contracted balance?

Do I need a referral to see the patient?

For Legend and Heritage plans: There is no need to obtain a referral prior to treatment of a patient who has the Specialty Benefit Amendment.

For UDC plans : Referral requirements differ for the UDC plans. Please contact Customer Relations at 800.443.2995.

For DentiCare: A referral is necessary only if the plan has an Specialty Benefit Amendment.

In all cases where an emergency referral to a specialist is required, the general dentist can call in an emergency referral

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How do I know if a patient has the Specialty Benefit Amendment?

If you have a question about member benefits or the eligibility of a specific patient, please contact Customer Relations at 800. 443.2995. Our representatives are available to assist you Monday through Friday from 7:00 a.m. to 5:30 p.m. CT.

How do I get reimbursed for services?

Some specialists must submit claims for reimbursement from the plan, as follows:

  • Legend plans with the SBA.
  • UDC plans.
  • DentiCare plans with the SBR.
For all other plans, services performed by specialists are discounted and the patient is responsible for the full discounted reimbursement. Please consult your plan materials or call Customer Relations at 800.443.2995 for assistance.

What is the Specialty Benefit Amendment (SBA)?

The SBA rider is offered with prepaid plans that provides members enhanced benefits associated with Plan Specialists, plus limited benefits with using a Non-Plan Specialists.

Do all patients have the SBA?

No, please verify whether or not the patient has the SBA before treatment. If the patient does not have the SBA then they are entitled to the applicable discount. 15% discount on endodontic procedures and 25% discount on all other specialty procedures.

How can I receive information about the SBA if I don't currently accept members with the SBA?

Please call Customer Relations at 800.443.2995. Representatives are available to assist you Monday through Friday from 7:00 a.m. to 5:30 p.m. CT.

If I do not wish to accept members with the SBA, what should I do?

Please fax a written request stating your desire to no longer see members who have the SBA.

Fax: 205.909.5264

Sun Life Financial
Attention: Provider Relations
PO Box 13157
Birmingham, Alabama 35202

Where do I submit an SBA claim for the remaining contracted balance?

Sun Life Financial
PO Box 830949
Birmingham, Alabama 35283