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Options to Get Cost & Benefits

There are two ways to get cost estimate and insurance benefits for your planned oral surgery procedure:

  1. Share your information and X-ray for pre-treatment estimate
  2. Contact your insurance company and get benefits

Please note:

  1. We are not member provider with any insurance plans, but with most insurance plans our fees are either the same or within the usual & customary fees (UCR)
  2. Any insurance benefits will be considered as out of network
  3. learn more about how insurances work
  4. We offer several payment plans

Get Estimate and Benefits Through Pre-Treatment Estimate

With this option, we will submit a pre-treatment estimate to your dental insurance to get exact benefits and out-of-pocket expenses. It typically takes 4-6 weeks to get a response unless you contact them directly and request to expedite.

  1. Complete form below
  2. Include all necessary information about insured and your insurance information
  3. Attach X-ray
  4. Submit
Oral Surgery Cost Estimate and Insurance Benefits
Drop a file here or click to upload Choose File
Maximum upload size: 104.86MB
Drop a file here or click to upload Choose File
Maximum upload size: 104.86MB
Drop a file here or click to upload Choose File
Maximum upload size: 104.86MB

Insurance Information

Please provide your insurance information for obtaining your benefits
Provide your insurance information below

Your Financial Needs

Any other comments or requests:

Sending

Call Insurance to Get Available Benefits

With this option, you can contact your insurance company, ask the following questions, and share it with our office along with your X-ray. We will then provide you with an exact cost and out-of-pocket expense. This option provides you a faster response and information so you can proceed sooner.

Contact your dental insurance company and inform them that you need extractions / other procedures done and you want to get your available benefits (download the worksheet below to help you get all the necessary information)

Get the following information from the insurance agent:

  1. Annual maximum for your dental benefits
  2. How much is left in your annual maximum
  3. The usual / customary rates (UCR) for the following procedures & codes:
    • Panorex X-ray
    • Consultation
    • Surgical tooth extraction
    • Extraction of partial bony impacted tooth
    • Extraction of full bony impacted tooth
    • Extraction of soft tissue impacted tooth
    • IV sedation anesthesia
    • Nitrous Oxide anesthesia
    • Bone grafting (two codes for this)
    • Dental implants if planned
    • [For other procedures and codes not listed, contact our office)
    • Is there a limit to number of Panorexes and has that limit been reached
    • The benefits for out of network providers
    • Address to send claims
    • Name of the agent assisting you.
  4. Complete the downloaded worksheet form below and complete the information given by your insurance company
  5. Email the worksheet along with  your X-ray to ‘patientcare@facialart.com