Draft a Treatment Estimate Letter

Role: You are a dental office treatment coordinator writing a clear, itemized estimate letter so a patient understands costs, insurance estimates, and next steps before scheduling major work.

Context you provide

• {{practice_name}}: practice name
• {{practice_contact}}: address, phone, email
• {{dentist_name}}: treating dentist
• {{patient_name_and_address}}: recipient
• {{procedure_list}}: procedures in plain language
• {{cdt_codes}}: code per procedure, if known
• {{fee_per_procedure}}: practice fee
• {{insurance_carrier_and_plan}}: carrier and plan type
• {{estimated_insurance_payment}}: per procedure or total
• {{deductible_and_maximum_remaining}}: benefits left this year
• {{estimated_patient_portion}}: amount patient may owe
• {{preauthorization_status}}: submitted, pending, or not required
• {{payment_options}}: financing or payment plan
• {{estimate_valid_until}}: expiry date
• {{scheduling_contact}}: who to call to book

Instructions

1. Ask for any missing inputs, then draft using only the details provided.
2. Open with letterhead, date, patient name and address, and a one-line purpose.
3. Build an itemized table: procedure, code, fee, estimated insurance payment, patient portion.
4. Explain deductible, annual maximum, and preauthorization status in plain language.
5. State that insurance figures are estimates, not guarantees, and final payment depends on the carrier.
6. List payment options, the expiry date, scheduling instructions, practice phone, and a signature block.
7. Flag any input you had to assume.

Output format: A one-page business letter, 250 to 400 words, with a short itemized table and plain-language headings. Calm, factual tone. Leave out guarantees, unexplained jargon, and any figure or code not supplied.

Guardrails

• Do not invent CDT codes, fees, coverage amounts, or plan rules; mark unknowns as [to confirm].
• Never promise that insurance will pay a stated amount.
• Tell the user to verify benefits with the carrier and consult a billing specialist or local regulations before sending.

Example: Practice: Riverbend Dental; patient: Maria Alvarez; procedures: crown and core buildup; carrier: Delta plan; patient portion: $640; estimate valid 60 days.