Why is this dental for one person and medical for another?

Because the two systems draw the boundary differently, and individual plans draw it differently again. A bony impaction with a documented indication often crosses into medical benefits; the same tooth in a different plan does not. We tell you which side we expect yours to fall on, and we submit to whichever pays first.

Do you give an estimate before treatment?

Always, in writing, before anything is booked. It lists the procedure codes, our fee, what we expect your plan to pay, and what we expect you to pay. If the plan pays differently from our estimate, we tell you as soon as we know rather than sending a surprise.

What is a predetermination and should I get one?

A predetermination is the insurer telling you in advance what they will cover for specific codes. For anything expensive or borderline — orthognathic surgery, full-arch, extensive grafting — yes, and we will submit it for you. It usually takes two to six weeks and it is worth the wait.

For a demonstration site we are deliberately not naming carriers, because a fabricated network list is exactly the kind of claim this build refuses to make. A real practice would list its participating plans here and update them.

What if I have no insurance?

You get the same written estimate, at the same fee. We would rather talk about the money before the surgery than after it, and we are happy to phase treatment where phasing it is clinically reasonable.

Do you offer payment plans?

Third-party healthcare financing is available for larger treatment plans, with terms set by the finance provider rather than by us. We will tell you plainly what the interest costs over the term. A demonstration site does not name providers.

The patient portion is due on the day of surgery. For staged treatment such as implants, the surgical and restorative phases are billed separately and by different practices — we bill for the placement, your own dentist bills for the crown.

Cost

What it costs, and who pays which part.

Surgical procedures sit across the boundary between dental and medical benefits. We will tell you which side we expect yours to fall on before you commit, not after the claim comes back.

EstimatesIn writing, before booking

PredeterminationSubmitted for us by request, 2–6 weeks

Billing questions(612) 555-0148

01 · The split

Dental benefits, medical benefits, or both.

This is the table people most want and least often get. It is a general guide, not a promise about your plan — plans differ, and yours is the one that decides.

Which benefit usually applies
Procedure	Usually billed to	Crosses over when
Third molar removal	Usually dental	Medical in some plans where there is pathology, infection or a bony impaction
Dental implant placement	Usually dental	Medical where the tooth was lost to trauma or to tumour resection
Full-arch restoration	Usually dental, often with an annual maximum reached early	Rarely medical
Bone grafting / sinus lift	Usually dental	Sometimes medical, particularly after trauma
Orthognathic surgery	Usually medical	Predetermination almost always required; documentation decides it
TMJ assessment and management	Varies widely — some plans exclude TMJ entirely	Read your policy on this one specifically
Biopsy and pathology	Usually medical	Laboratory fees are billed separately by the pathology service
Facial trauma	Medical	Often with an emergency department claim alongside

02 · How it runs

From estimate to statement.

Before

A written estimate

Procedure codes, our fee, expected plan payment, expected patient portion. Given at the consultation, before anything is scheduled.

If it is large

A predetermination

We submit the codes and the clinical documentation and wait for the insurer's answer in writing. Two to six weeks, and worth it for anything expensive or borderline.

After

One statement

What the plan paid, what it did not, and why. If the plan pays differently from our estimate, we call you rather than posting a surprise.

Billed separately by someone else: histopathology, when a specimen goes to a laboratory; hospital and anaesthetist fees, for anything done under general anaesthesia in a hospital; and your own dentist's restorative work after implant placement. We will tell you which of these apply to your plan before you start.

Questions