What is the difference between predetermination and preauthorization?

The terms are often used interchangeably, but there's a real difference. A predetermination is an estimate that your insurance expects. A preauthorization is an approval that must be obtained before proceeding with treatment.

Insurance, handled with care

Know what your treatment will cost beforeyou sit down.

We submit predeterminations to your insurance for major procedures, so you get a clear, written estimate of your coverage and out-of-pocket cost. No surprises. No guessing.

Request a predetermination How it works

the basics

What, exactly, is a predetermination?

A predetermination is a request we send to your dental insurance carrier before treatment begins. We submit your proposed treatment plan along with any required x-rays, charts, or clinical notes.Your insurer responds with a written estimate of what they'll cover and what you'll be responsible for. Think of it as a preview of your benefits — applied to your specific treatment plan, not a generic coverage chart.It's the difference between an educated guess and an informed decision.

When we recommend it

Most useful for treatment that's costly, complex, or where coverage rules can vary.

Crowns, bridges & onlays

Dental implants

Dentures & partials

Periodontal surgery

Oral surgery & extractions

Orthodontics & aligners

Scaling & root planing

TMJ & occlusal therapy

For routine cleanings, exams, fillings, and most preventive care, predeterminations usually aren't needed, coverage is predictable and we can quote you accurately at your visit.

The process

Five steps, handled by us.

01 Treatment planning

After your exam, we'll review your recommended treatment together and flag any procedures where a predetermination makes sense.

02 Submission

We compile the required documentation — codes, fees, narratives, and supporting images — and send it directly to your insurance carrier.

03 Carrier review

The insurer evaluates your plan against your benefits. Most responses come back within two to four weeks, though it can vary.

04 Your written estimate

We walk you through the response: what's covered, what you'll owe, any alternative benefits applied, and what's not covered and why.

05 Scheduling, on your terms

Once you've reviewed the estimate, you decide whether and when to proceed. There's no obligation, ever.

A useful distinction

Predetermination vs. Preauthorization.

The terms are often used interchangeably, but there's a real difference. We handle both — and we'll tell you which one your plan and procedure require.

An estimate

Predetermination

Tells you what your insurer expects to pay based on your benefits at the time of submission. Not a binding guarantee — final payment depends on eligibility on the date of service.

Vs.

An approval

Preauthorization

A formal approval the insurer must issue before certain procedures — without it, the claim will be denied. Required by some plans for specific treatments.

Your part

What we need from you.

That's it. We handle the paperwork,
the follow-up calls, and the back-and-forth
with your carrier.

Current insurance information
(a photo of your card is fine)

Secondary insurance details, if applicable

Updates if your coverage or employer changes

A little patience while your carrier responds

Know what your treatment will cost beforeyou sit down.

Ready to transform your dental practice?