If you’ve ever spent time waiting for a dental pre-authorization to come back—only to receive a vague approval or worse, a denial—you’ve probably wondered: Is this even worth it?

Pre-authorizations (also called pre-determinations or treatment estimates) are a common part of dealing with dental insurance, but their value is often debated in dental offices. Do they help clarify coverage and protect your practice from unexpected denials, or are they just administrative busywork with no real guarantees?

Let’s break it down so you can make an informed decision on when (or if) to use them in your practice.

What Is a Pre-Authorization?

A pre-authorization is a request submitted to a dental insurance plan before treatment begins, asking for confirmation of coverage and benefit eligibility for specific procedures.

Insurers review:

• The patient’s plan details,

• Annual maximums,

• Frequency limitations,

• Medical necessity, and

• Any exclusions or conditions.

Then, they send back a pre-determination of benefits, stating what they would cover—under current conditions.

Here’s the key: Pre-authorizations are not a guarantee of payment.

Pros: When Pre-Authorizations Are Worth It

Improved Patient Communication

Pre-authorizations provide written estimates that help you clearly explain:

• What the insurance may cover,

• What the patient will likely owe, and

• Why treatment is needed.

Patients appreciate transparency, and having an estimate in writing builds trust—especially for high-cost or elective procedures.

Better Financial Planning

When you’re dealing with major treatments like crowns, implants, or periodontal surgery, a pre-auth can help you:

• Confirm whether the patient has coverage,

• Estimate their out-of-pocket costs, and

• Avoid surprises that can lead to unpaid balances or broken appointments.

Documentation and Leverage

If a claim is denied after being pre-authorized, the pre-authorization can be used as leverage in an appeal. It’s proof that you did your due diligence and that the insurer had previously reviewed and “approved” the proposed treatment.

Cons: When Pre-Authorizations May Waste Time

Not Legally Binding

Even with a pre-auth, insurance companies can (and often do) deny the final claim based on:

• Changes in patient eligibility,

• Benefit maximums being met in the meantime,

• New policy updates, or

• Retroactive plan terminations.

That means the time you spent waiting for the pre-auth could still result in a denied claim.

Delayed Treatment

Waiting 2–3 weeks (or more) for pre-authorization can delay care—especially for patients who need prompt treatment. Delays may cause conditions to worsen, and patients might postpone or cancel if they lose momentum or become anxious about cost.

Administrative Burden

Pre-auths require staff time, paperwork, documentation, and follow-ups. For low-cost or routine procedures, the ROI may not justify the effort, especially if your acceptance rate is high and most treatments move forward anyway.

So… Are They Worth It?

It depends on the situation. Here’s a smart way to approach it:

Use Pre-Authorizations When:

• Treatment costs are high or out-of-pocket estimates are significant.

• The patient has financial concerns or has requested it.

• You're treating out-of-network or unfamiliar plans.

• The procedure is often questioned or denied (e.g., crowns, perio surgeries).

• Documentation will protect you in appeals.

Skip Pre-Authorizations When:

• The procedure is routine, like cleanings, fillings, or bitewings.

• You have in-network certainty and know the plan well.

• Delaying treatment could compromise care.

• The time and effort outweigh the financial risk.

Best Practice: Educate and Document

If you choose to skip the pre-auth, protect your practice by:

• Clearly communicating to the patient that coverage is not guaranteed,

• Providing written treatment estimates, and

• Having patients sign a financial agreement acknowledging responsibility for uncovered charges.

This reduces the risk of complaints or bad debt if insurance doesn't pay as expected.

Final Word

Pre-authorizations aren’t inherently good or bad—they’re a tool. When used strategically, they can help you manage risk, improve communication, and support collections. But used too often, they can bog down your team and delay needed care.

Know when to use them, when to skip them, and always empower your patients with the information they need to make confident treatment decisions.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com