How Do I Request Preauthorization for Dental Implant Treatment

If you have dental insurance and your dentist says you need a dental implant, your next move usually isn’t “book the surgery.” It’s figuring out whether your plan wants preauthorization (sometimes called prior authorization) or whether it only needs a predetermination of benefits. Getting the right go-ahead—and submitting it the right way—can be the difference between “covered” and “denied because the paperwork wasn’t in place.”

Below is a patient-ready checklist that walks you through the process step by step, in the same order you’d typically do it: confirm the rules, gather documents, use the right codes, submit through the required channel, and track the result.

Check whether your plan requires preauthorization (and for which codes)

Start with your plan rules. Many plans—especially DHMO plans—require preauthorization before you’re referred to a specialist. The goal is straightforward: the plan reviews the treatment that was prescribed and decides whether it will authorize payment.

Here’s what to do first:

• Look up your plan’s preauthorization list (if it has one). Some insurers publish a list that shows which procedure codes require preauthorization based on things like site of service and diagnosis codes.
• Call or use the plan’s website/portal and ask:
• Do you require preauthorization for dental implants?
• If yes, is it required for the implant placement only, or also for the exam, imaging, bone graft, crown/abutment, etc.?
• Is preauthorization required before referral to the specialist?

If you skip this step, you can end up with a provider order you can’t get paid for.

Predetermination vs. preauthorization: when each is used

People mix these up, so here’s the clean way to think about it:

Predetermination of benefits (a “check before you go”)

A predetermination request lets you ask the insurer what benefits they’re likely to pay for a specific treatment plan. Depending on the insurer’s rules, it may be submitted through their process (for example, electronically or by mail).

Think of it as: *“What would you cover if we do this?”*

Preauthorization (a “permission before the service”)

Preauthorization is often required when your plan wants to review the treatment prescribed first. This is especially common with plans that require preauthorization prior to referral.

Think of it as: *“Can we do this, and will you authorize payment, based on what you’re being asked to approve?”*

When to use which

Follow your plan’s instructions. In most cases, the fastest path is:

• If your plan says preauthorization is required, submit a preauthorization request.
• If your plan says predetermination is the path (or they offer both), follow their process for the type of review they want.

In either case, the key is the same: submit using the plan’s instructions (online portal, phone, or the payer’s submission channel).

Verify benefits upfront before you submit

Before anyone sends paperwork, confirm what the plan says you have in your coverage account.

Your checklist here should be short and practical:

• Confirm you’re eligible for coverage on the date the work will be done.
• Ask what’s covered and what requirements the plan typically applies to implants.
• If your plan uses limits (like annual caps, benefit categories, or exclusions), ask how those apply to the implant components.

Then do one more thing that people often miss: confirm what the payer wants in the request. Even if you have the right codes and documents, one missing item can slow things down or derail the review.

Collect the documents your insurer typically expects

Your request is only as strong as what you submit. Insurers usually want clinical information that supports the treatment being requested. Collect what your dentist/specialist has, and make sure it matches what you’re asking the plan to approve.

Plan for items like these (your provider can usually help with them):

• Treatment plan / prescribed procedure details (what’s being planned and, if relevant, what tooth area)
• Clinical records that support why the implant is recommended
• Imaging or diagnostic information used to plan the treatment
• A clear list of the procedures the provider expects to do (implant placement and any related steps)

Key point: insurers review what’s submitted. If the request doesn’t match what your dentist plans to do, the decision may not reflect your actual treatment.

Use the right codes (CDT/CPT) for the implant work

Insurance reviews are code-driven. That means you need the correct CDT/CPT codes for each part of the implant process.

• Ask your dental office to confirm they’re using the right procedure codes for the services being requested.
• If your provider submits claims, ask them to make sure the preauthorization request matches the codes they’ll use later.

Why this matters: many preauthorization decisions depend on whether the request includes the correct codes. If a code is missing or incorrect, the plan may deny the request or ask for more information.

Also, if your plan has a “preauthorization list,” use it as your guide. These lists are meant to show which procedure codes require preauthorization, and how site-of-service and diagnosis can affect the requirement.

Submit the request using your payer’s required channel (portal, phone, or EDI)

This is where many people get stuck. You can’t submit a form however you want. You have to send the request through the required channel your insurer sets.

Common submission paths include:

Option A: Online portal or phone instructions

Some plans tell you to submit through their member portal or to start the request by calling them. Follow the directions exactly.

Option B: Electronic submission via the dental payer’s process (EDI)

For example, UnitedHealthcare dental guidance says prior authorization of care should be requested electronically using a standard EDI transaction submission through their dental system.

Your dentist or specialist may already know the workflow, but it’s still worth confirming what your specific plan expects:

• Will the provider submit it through EDI?
• Or does the plan require the office to use a specific dental submission channel?
• Or do you need to submit something through your member portal?

Option C: Mail (if the insurer’s process uses paper)

Some insurers allow predetermination requests to be sent electronically or by mail, depending on the request type. If your plan uses mail for certain requests, follow their instructions.

If you’re not sure which channel applies, call the insurer and ask: “Where do I submit a preauthorization request for dental implant treatment, and what format do you need?”

Track the status and respond to insurer follow-ups

After you submit, don’t assume it automatically moves forward. Preauthorization requests often involve back-and-forth.

Here’s how to handle it efficiently:

• Get confirmation that the request was received (a reference number helps).
• Track the request using the insurer’s portal or by calling.
• Watch for follow-ups. Insurers may request:
• More clinical documentation
• Clarification of the treatment plan
• Confirmation of codes
• If the insurer asks for more information, respond quickly. Delays often happen when documentation doesn’t reach the payer fast enough.

Also, keep your own file together. You don’t need a huge binder—just copies of:

• The treatment plan request
• Any submission confirmation
• Any responses from the insurer

If you’re denied: what to do next

A denial doesn’t always mean “never.” Often, it means “not approved based on what was submitted.”

Start by finding the reason. Your denial letter or insurer response should say what to fix.

Common next steps:

• Ask what documentation was missing or what the plan needs to support the request.
• Ask whether the decision was based on medical necessity criteria.
• Confirm whether you should request a different type of review (predetermination vs. preauthorization) if your plan offers both.
• Work with your dental office to resubmit with:
• Correct codes
• Updated clinical documentation
• Any additional imaging or notes the plan requested

If you’re dealing with lots of back-and-forth, ask your provider to help drive the process. Many plans expect the clinical team to supply the details.

Common questions: medical necessity, who can request, and timing

Is dental implant treatment considered “medically necessary”?

Insurers decide based on their own criteria for “medically necessary.” That usually means your request needs clinical documentation that explains why an implant is being prescribed.

If the plan is questioning medical necessity, that’s where your strongest documentation matters most. Ask your provider to align the clinical story with what the insurer is looking for.

Who is responsible for getting preauthorization: you or the provider?

It depends on the plan, but here’s the practical answer:

• Many preauthorization requests are handled by the provider (your dentist/specialist) because they have the clinical details and often submit through the payer’s system.
• Some plans also let you start the process or submit certain requests yourself through the insurer’s phone line or portal.

If you want to be sure, call your insurer and ask:

• “Who submits the preauthorization request for dental implants for my plan?”
• “If the provider submits, what do I need to do to make sure it happens?”
• “If I can request it myself, what’s the exact process and channel?”

How long does a dental pre-authorization take?

Timing varies by insurer and by how complete the request is. Since timelines differ, the best move is:

• Ask after you submit what turnaround time they expect.
• Also ask what commonly causes delays (missing codes, missing clinical documentation, or the need for more information).

If you want to avoid delays, double-check that your request includes the correct codes and the clinical documentation the plan expects before it’s submitted.

How to get insurance to cover a dental implant

Here’s the most reliable path, in plain steps:

1. Verify benefits upfront so you know your coverage rules.
2. Confirm whether your plan requires preauthorization (often before referral) or predetermination.
3. Make sure your request includes the correct CDT/CPT codes for each part of the implant work.
4. Gather and submit clinical documentation that supports the treatment prescribed.
5. Submit through the insurer’s required process (portal/phone/EDI/mail).
6. Track the request and respond quickly if the insurer asks for more information.

Can I request my own prior authorization?

Often, yes, but it depends on the insurer’s process. Follow the insurance company’s instructions for how prior authorization should be requested (phone or online portal).

If you want to do it yourself, ask the plan:

• Whether members can submit preauthorization requests
• Which channel they want (portal vs. phone)
• Whether the provider still needs to submit certain clinical paperwork

A patient-ready preauthorization checklist (use this before your appointment)

Use this right before your next dental visit or before the specialist starts working up the treatment plan:

• [ ] Call your insurer or check the portal to confirm whether preauthorization is required for dental implants (and which codes).
• [ ] Ask whether you need preauthorization before referral (common in DHMO plans).
• [ ] Confirm whether your plan uses predetermination or preauthorization for this situation.
• [ ] Ask your dentist/specialist to use the correct CDT/CPT codes for the implant work being requested.
• [ ] Gather what you can from the office (treatment plan, diagnostic info, and any required clinical records/imaging).
• [ ] Submit through the insurer’s required channel (portal/phone, or the provider submits through the payer’s electronic process like EDI).
• [ ] Save the confirmation/reference number and set a reminder to track the status.
• [ ] Be ready to answer insurer follow-ups quickly with any additional documents they ask for.

Before your appointment, gather your documentation and call or log into your insurer’s portal to submit the preauthorization request using the required channel.