Insurance & Billing

Clear Answers. No Guessing.

Insurance can be confusing—especially when you’re trying to make the right decision for your health. Our goal is to make the financial side of care straightforward so you know what to expect before treatment begins.

At O2 Dental Group, we'll help you:

Note: Important: Insurance benefits are determined by your plan—not the dental office. We can verify and estimate benefits, but coverage and payment are ultimately decided by your insurer.

Dental Insurance Basics

Most dental insurance plans include:

Annual maximums

A yearly cap on what the plan pays

Deductibles

What you pay first

Co-insurance

A percentage you may owe

Waiting periods

Some plans delay certain benefits

Coverage rules

That vary by preventive/basic/major services

If you’re unsure what your plan covers, we can help verify benefits and provide an estimate before starting treatment.

Dental Billing vs. Medical Billing — What's the Difference?

Most routine dentistry is billed to dental insurance. However, some services may be billed to medical insurance when they’re tied to a medical diagnosis or medical necessity.

Dental Billing

Typically applies to:

Medical Billing

May apply (case-dependent) when care is connected to:

Note: The same procedure can be “dental” in one situation and “medical” in another—depending on diagnosis and plan rules. If you’re not sure, request a benefits check and we’ll guide you.

Dental Plans We Commonly Work With

We work with many PPO plans and can help patients understand their benefits and estimates. Plans and network participation can vary by location.

Common plans we accept and/or frequently file with include (not all-inclusive):

Note: This list is not all-inclusive, and network status can vary by location and plan type. If you want a definitive answer, request a benefits check and we’ll verify your specific plan.

When Medical Insurance May Help (Medical Billing Support)

In certain situations, medical insurance may contribute toward dental/oral care when the procedure is tied to a medical diagnosis, trauma, pathology, or a medically necessary condition.

If your case fits medical criteria, we can help guide the process and documentation requirements.

Examples of Procedures That May Be Eligible for Medical Coverage (Case-Dependent)

Coverage varies by plan and diagnosis, but medical insurance may sometimes help with:

Sleep & Airway

Sleep apnea oral appliances (oral appliance therapy)
Snoring evaluation pathways when tied to medical sleep evaluation

Oral Surgery / Medical Necessity

Surgical/complicated extractions (in select medical scenarios)
Procedures related to infections that require surgical management (case-dependent)

Pathology / Lesions

Oral evaluations for suspicious lesions
Biopsies and pathology-related procedures

Trauma / Accidents

Treatment related to facial or dental trauma from accidents/injuries
Trauma-related imaging or stabilization (case-dependent)

Bone Grafting / Implant-Related Medical Cases

Bone grafting associated with trauma, pathology, or other medically documented needs
Implant-related services when part of medically necessary reconstruction (case-dependent)

Periodontal / Gum Disease in Medically Necessary Cases

Periodontal treatment required for medical clearance or risk reduction in certain healthcare situations (case-dependent)

Medically Driven Restorative Needs

Restorations/crowns needed due to medically documented conditions that cause tooth damage (examples may include severe erosion related to GERD or other diagnosed medical conditions), when plan criteria are met (case-dependent)

Note: We do not guarantee medical coverage or approval. Every plan has its own rules, and documentation requirements can be strict. We’ll help you understand the path and what to expect.

What We Can Help With

Depending on your plan and the type of treatment, our team may be able to assist with:

Payment Options

We offer multiple ways to pay, which may include:

Credit/debit cards

CareCredit

HSA/FSA (when applicable)

Sunbit financing

Finance through a local credit union we partner with

In-house payment plans (for select cases)

We’ll review options clearly so you can choose what fits your situation.

Request an Insurance / Benefits Check

If you’d like help understanding benefits before treatment, complete the form below and our team will contact you within 1 business day.

Benefits Check & Billing Questions

Full Name *

Email *

Phone Number *

Preferred Location *

Best Time to Contact *

Coverage Type

I have: *

Insurance Provider Name *

Member ID *

Group Number *

If This Involves Medical Billing (Optional)

What is this related to? *

Have you been diagnosed by a physician? *

Upload supporting document (Optional)

Drag & Drop Files, Choose Files to Upload

What can we help you with?

Checkboxes *

I consent to be contacted by O2 Dental Group by phone/text/email regarding my request.

Frequently Asked Questions

General Insurance & Billing

Are you in-network with my insurance?

Network status can vary by location and plan type. Request a benefits check and we’ll verify your specific plan.

Will insurance cover my entire treatment?

Most plans do not cover 100%. Coverage depends on your annual maximum, deductible, co-insurance, and plan rules.

Can you tell me exactly what my insurance will pay?

We can provide an estimate based on verification, but the insurer makes the final decision when the claim is processed.

Do you offer payment plans or financing?

We offer multiple payment options and financing may be available depending on eligibility and treatment type. We also offer Sunbit financing and in-house payment plans for select cases.

What if I don’t have insurance?

You can still receive care. We’ll review costs and options so you can make a confident decision.

Medical Billing (Including Sleep Apnea)

Do you bill medical insurance?

In select situations, yes—when care is tied to medical necessity (such as sleep apnea appliances, trauma, pathology/biopsy, certain grafting/reconstruction cases, and other medically documented conditions). Coverage varies by plan.

Do you guarantee medical coverage or approval?

No. Coverage and approvals are determined by your insurer. We can help verify benefits and guide documentation requirements.

Do I need a physician diagnosis for medical billing?

Often yes. Many medical-billed cases require documentation from a physician or medical provider and may require specific diagnostic criteria.

I’m not sure whether my case is dental or medical. What should I do?

Start with the benefits check form. We’ll review what you share and guide you to the most appropriate path.

Insurance Disclaimer: Insurance benefits and coverage are determined by your insurer and plan. Estimates are not a guarantee of payment. Patient responsibility may change based on how claims are processed.

Medical Billing Disclaimer: Medical billing support depends on diagnosis, documentation, and plan criteria. Coverage is not guaranteed and may require physician records and/or additional approvals.