Insurance and billing
Predetermination
Also called predetermination of benefits, pre-treatment estimate, pre-estimate
A request asking the insurer what it would likely pay for planned treatment, giving the patient an estimate before starting.
A predetermination is sent to the insurance company before treatment so the office and patient can see what the plan expects to pay. It is usually optional and helps with larger treatments such as crowns, bridges or implants. The reply is an estimate, not a guarantee, and it can change if the patient's coverage changes or limits are reached. The answer can take days or weeks, so plan the schedule around it.
Example at the front desk
I submitted a predetermination for the bridge so she can see her share before she commits.