A) We at Elite Medical Dental Management (EMDM) have deep expertise in establishing medical necessity which may qualify you for getting your medical insurance to pay for a full mouth of dental implants/implant supported prosthetics.
A) Cost of a full mouth of dental implants/implant supported overdentures may range from $30,000 to $70,000 depending on the number of implants used (4 implants per arch or 6 implants per arch) and the type of implant supported prosthesis. However, if your medical insurance covers those implants, then you may only pay a low deductible/out of pocket which typically may range from $1,000 to $8,000.
A) Our assessment is at no charge to the patient. Once we are able to assess if implant coverage is available, we connect you with one of our credentialed providers who will then contact your medical insurance to establish medical necessity and to obtain the necessary pre-authorizations. All our credentialed providers offer payment plans for deductibles and out-of-pocket expenses, should you need help there.
A) Establishing medical necessity for dental implants is a complex process that our experts at EMDM have deep expertise in. At no cost to you, the experts at EMDM can review your medical history and help build a comprehensive case to prove medical necessity. EMDM will involve a participating Dental Provider who will then help you with completing your treatment.
A) There are a large number of criteria which could qualify a dental treatment with implants as a medical necessity. Some examples are:
(1). When certain medications that are used to address a medical condition cause significant damage to teeth. Examples of such medications are heartburn medicines, anxiety medicines, diabetes medicines, weight loss medications, muscle relaxers, anticonvulsants, antihistamines, antidepressants, ADHD medicines, analgesics, bronchodilators, anticholinergics, diuretics, antihypertensives (High Blood Pressure), Parkinson's disease medications, chemotherapeutic agents, etc.
(2). When certain conditions such as radiation therapy for cancer cause significant tooth deterioration/bone loss.
(3). When certain medical procedures (Example a gastric bypass, Gastric Sleeve) result in issues which cause significant tooth deterioration/bone loss.
A) Below is the 7-step process to get your medical insurance to pay for dental implants:
Step 1: Click on the link for the Insurance Assessment Form.
Step 2: An email will go from our platform to upload front and back of your ID and Insurance card in a HIPAA protected environment. Know your privacy rights under HIPAA by clicking here - https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html
Step 3: We verify implant/implant based prosthesis coverage with your medical insurance. We will send a denial email to you if there is no implant coverage. Please note that implant coverage is typically available with PPO plans only. HMO, EPO and Medicare based plans do not typically provide for any implant coverage.
Step 4: Once implant coverage is established, we send a detailed questionnaire to capture medical history, medications, and an assessment of the current situation and how it is affecting your daily life.
Step 5: Next we schedule a medical consultation with one of our participating providers. At the consult advanced radiographs (CBCT) are taken to assess the condition of the teeth and bone loss (atrophy). There is no charge to the patient for this diagnostic assessment. A detailed medical necessity documentation is created and submitted to your medical insurance company. If we are not able to establish medical necessity, we will inform you. In that case we will offer alternative treatment and payment plans which may be combined with your dental insurance to come up with an affordable implant-based solution.
Step 6: For those patients for whom we can establish medical necessity, we request the insurance company to pre-authorize the treatment. We will then set up options for payment plans for deductibles/out of pocket should you need one.
Step 7: Treatment is rendered, and you have a beautiful smile.
A) We typically place 6 implants in each arch with advanced bone grafting as opposed to 4 implants which are typical for most “all-on-X” implant solutions. 6 implants have the following advantages over 4 implants in each arch as: