Dental Predeterminations: How to Check Coverage before Treatment

What a dental predetermination is

A dental predetermination, sometimes called a pre-treatment estimate, lets you check with your insurer before you start. Your dentist sends the plan the proposed treatment, with the procedure codes and fees. The plan writes back with how much of each item it expects to pay.

The Ontario Dental Association notes that a predetermination doesn't promise coverage. What it does is show which services are covered and what limits the plan applies. That makes it one of the most useful tools for avoiding surprises.

Predetermination vs dental pre authorization

People often use these terms as if they mean the same thing. With private insurance, a predetermination is usually optional. You or your dentist ask for one to plan ahead.

With the Canadian Dental Care Plan, the step is called preauthorization, and for some services it's required. As of October 2026, Canada.ca lists crowns, root canal re-treatment, partial dentures and certain kinds of sedation, along with any service beyond the plan's frequency limits. Not every request is approved. When a dental pre authorization is granted by the CDCP, it is generally valid for 12 months, or 24 months for some preventive and gum services.

When it's worth asking for one

You don't need one for a routine checkup. It helps most with larger or multi-step treatment:

• Crowns, bridges, implants or dentures
• Root canal treatment, especially on a back tooth
• Orthodontic treatment, such as braces or clear aligners
• Wisdom teeth removal, especially with sedation
• Gum treatment that may take several visits
• Any plan where you're unsure what your insurance pays

How the process works

The steps are usually simple:

• Your dentist examines you and proposes a treatment plan.
• The office sends it to your insurer, often electronically, with X-rays or notes if needed.
• The insurer reviews it against your plan's terms.
• You and the office receive a reply showing the expected payment for each item.
• You review your share and decide whether, and when, to go ahead.

How long it takes

Timing depends on the insurer and on how involved the treatment is. Simple electronic requests may come back quickly. Others take longer, especially if the plan asks for more X-rays or information. For the CDCP, the ODA says replies to preauthorization requests can take several weeks or longer.

If you're in pain or have an infection, don't let paperwork hold up urgent care. Your dentist can relieve the problem first and plan the larger work once the reply arrives.

It also helps to keep your own copy of each reply. If treatment is spread over several months, you can check it against your claims as they're paid and spot any gap early.

Why the final payment can still differ

Because a predetermination isn't a promise, the amount paid can change. Common reasons include:

• Other claims use up your annual maximum before treatment happens.
• Your plan changes, or you change jobs.
• The treatment changes once it starts, for example when a filling becomes a root canal.
• A frequency limit or deductible applies on the date of service.
• Two plans coordinate differently than expected.

It's about payment, not your care

The ODA is clear that insurers can't make treatment decisions for you. A predetermination tells you about money, not about what your teeth need. If a plan declines an item, that care may still be the right choice. You and your dentist decide together, and you can ask about other options or a staged plan. If you feel unsure about a proposed plan, you can always ask another dentist for a second opinion as well.

How we handle it in Aurora

If you're in Aurora or nearby, our team can send a predetermination to your insurer after your exam, or a preauthorization request to the CDCP when one is required. When the reply comes in, we go through it with you alongside your written estimate, and you can take your time before booking treatment.

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