Choosing to submit a pre-treatment estimate (PTE) for dental treatment has its pros and cons. Some will argue that waiting for a PTE just gives patients the opportunity to delay treatment and will be less likely to move forward with recommendations later.
However, getting a PTE from dental insurance companies can give you information that the dental office may not have retrieved from a simple breakdown of benefits, i.e., waiting periods, downgrades, alternate benefits, or hidden non-covered services. A PTE can even let a dentist know if teeth have a favorable enough prognosis (in the eyes of the insurance company) to qualify for benefits.
Knowing whether or not your patient will qualify for benefits positions you to be the "good guy," instead of assuming something will be covered and asking the patient to pay more for it after treatment has been started. When utilized, PTEs should be submitted with periapical radiographs, clinical photos, and periodontal charting, when necessary.
By Dr. Megan Keck, Dental Benefits Subcommittee