Turn confusing health bills
into a clear action plan

What is a dental insurance predetermination?

A predetermination is a pre-treatment estimate submitted to your insurer. It confirms allowed amounts, coverage levels, and alternate benefits before you commit to treatment.

Step 1: Get the itemized CDT codes

Ask the office for every CDT code and fee. Without the full list, insurance cannot give accurate numbers.

Step 2: Request the ADA form submission

Have the office submit a predetermination with X-rays and notes. Ask for confirmation that the form went to every plan you have.

Step 3: Review allowed amounts

The response shows the allowed amount, deductibles, and any alternate benefits. This is your leverage to negotiate before treatment.

• Confirm no balance billing in writing.
• Check whether a cheaper alternate benefit applies.
• Compare primary and secondary coverage if you have two plans.

Step 4: Use the response to lower your bill

Bring the predetermination back to the office. Request adjusted fees, re-coding, or scheduling changes based on the insurer response.