Insurance and Billing
Pre-authorization (pre-determination)
Pre-authorization or pre-determination is a review before treatment in which the dentist sends a treatment plan to your insurer to learn what the plan expects to pay.
In a pre-determination, the dentist submits a treatment plan to the insurer before treatment begins. The insurer reviews it and tells you and your dentist about your eligibility, covered services, amounts payable, and plan maximums. Some call it a pre-treatment estimate.
Pre-authorization is a close relative. It is a process the plan uses to decide whether certain services, such as crowns, are covered before you receive them. HealthCare.gov says it is not a promise your plan will cover the cost.
The response is an estimate, not a promise of payment. Your annual maximum, waiting periods, and eligibility on the day of care can change the result. Your treatment plan is what the dentist submits. See the insurance and financing page.