Dental predetermination: when to send one

A predetermination, also called a pre-treatment estimate or pre-estimate, is a treatment plan sent to the insurer before the work is done. The insurer answers with what it expects to pay for each procedure under the patient's plan as it stands that day: coverage, deductible, maximum used so far, limits and exclusions. For a large case it's the surest answer an office can get before the patient commits.

It isn't a pre-authorization or a promise

Insurers say plainly that a predetermination is optional and isn't a guarantee. Delta Dental of Michigan calls it a voluntary written estimate that is "not a claim for benefits or a preauthorization." United Concordia Dental says "a predetermination is not a preauthorization; it is not required." What's paid is decided when the claim comes in, so the answer can change if, by the date of treatment:

• The patient is no longer covered, or has changed plans.
• Other claims have used more of the yearly maximum or met a frequency limit.
• The deductible, coordination with a second plan, or other plan rules apply differently.

MetLife says actual payments "may vary from the pretreatment estimate depending upon annual maximums, deductibles, plan frequency limits and other plan provisions at time of payment."

When to send one

• Over about $300. MetLife and Delta Dental of Virginia both suggest one for treatment expected to cost more than $300.
• Crowns, bridges, implants, dentures and oral surgery. Delta Dental of Virginia names prosthetic, orthodontic, implant and oral surgery cases. United Concordia Dental lists wisdom teeth removal, gum surgery, crowns and bridges.
• When a downgrade or missing tooth rule might apply, so the patient sees the plan's own answer before agreeing.
• Not for emergencies. Urgent care shouldn't wait for the answer.

What to send

Send the treatment plan with each procedure and tooth, your fees, and what supports the need for the work, so the insurer doesn't have to ask for more and restart the clock. Delta Dental of Virginia asks for the treatment plan and pre-operative X-rays, and its attachment rules list periodontal charting for gum treatment and a short narrative for some procedures. Most offices send:

• Current pre-treatment X-rays of the teeth involved.
• Periodontal charting for deep cleaning or gum surgery.
• A short narrative for what an X-ray can't show, such as a cracked tooth.
• Intraoral photos where they help.

How long it takes, and how long it lasts

Delta Dental of Michigan asks offices to allow 10 to 14 business days when everything comes with the first request, and says sending it online is faster. Missing X-rays or charting add another round. How long the answer stays good varies by insurer: Delta Dental of Virginia's is valid for one year, and others set their own period, so check the date on the response before you schedule.

Steps for the front desk

1. Check eligibility and the maximum left on the benefits page first. If the case is small or urgent, quote from the page and skip the wait.
2. Send the predetermination with the treatment plan, X-rays and charting, through the insurer's portal when it has one.
3. Give the patient a written estimate from the plan's benefits page while you wait, marked as an estimate.
4. When the answer comes, compare it line by line with your estimate. Note any downgrade, frequency limit or exclusion.
5. Review the final numbers with the patient, and say that payment still depends on coverage on the day of treatment.

How Tabruns helps

Tabruns turns the patient's benefits page into a line-by-line estimate in seconds, so the patient gets a clear number on the day of the visit, before any predetermination comes back. When the insurer's answer arrives, compare it with the estimate and correct any line with the pencil; see correcting a value. The arithmetic is in how to calculate a dental patient portion, and what to check first is in the insurance verification checklist.

Sources, all read November 14, 2026: Delta Dental of Michigan, Pre-treatment estimate; United Concordia Dental, Predeterminations; MetLife, Group dental insurance; Delta Dental of Virginia, Participating dentists' handbook 2026.