You've found a dentist you want to see, and then the practical question lands: can I use my dental insurance there? Maybe you've paid premiums for years and don't want to leave those benefits on the table. Maybe you're on Medicare and aren't sure what counts. Or maybe you're dreading a stack of claim forms you'll have to figure out on your own.

The short answer

At Redefine Dental Aesthetic and Wellness Center, we file the claim with your insurance for you, so if your plan has out-of-network dental benefits, you can use them. Medicare and Medicare Advantage plans with out-of-network benefits are accepted the same way. HSA and FSA cards work for qualified dental care, and you can split treatment into monthly payments through Cherry. If you don't have dental insurance at all, the Smile Wellness Membership covers your preventive visits for a monthly fee and takes 10% off other treatment, with some exclusions. Your plan decides what it pays. Our job is to help you use every benefit you have.

How we file your claim

The paperwork is ours, not yours. Here's what happens.

• Bring your insurance card to your first visit. We note your plan details along with your health history.
• We plan your care around your mouth. I'm Darya Timin, DDS, FAGD, and I build every treatment plan from your gums, your bite and your overall health first.
• We file the claim with your plan for you. It goes in with the treatment details your plan needs to review it.
• Your plan pays according to your out-of-network benefits. You'll get a statement from your plan, often called an explanation of benefits, showing what it paid.

Out-of-network benefits vary from plan to plan. The percentage your plan pays and your yearly maximum are set by your plan, which is why a short call to your plan before treatment is worth it.

What insurance has helped pay for

Depending on the plan, insurance has helped cover three kinds of treatment at our practice:

• Dental crowns, at $2,750 per crown.
• Night and day guards, at $1,419, custom-made for your bite.
• Deep cleanings, at $1,802 for deep cleaning with salivary testing, one combined fee that covers the cleaning below the gumline and the saliva test that shows what's driving the gum problem.

Your plan decides what it covers, and every plan is different. Cosmetic treatment like veneers follows its own rules, which I walk through in whether dental insurance covers any part of veneers.

Medicare and Medicare Advantage

If you have Medicare or a Medicare Advantage plan with out-of-network benefits, you can use it here, the same way: we file the claim, and your plan pays according to its benefits. Many Medicare Advantage PPO plans let you use out-of-network providers for covered services. Dental benefits differ from plan to plan, so check two things with yours: whether your plan includes dental benefits, and whether those benefits extend to out-of-network dentists.

HSA, FSA and Cherry monthly payments

HSA and FSA cards are accepted. Money in a health savings account is set aside before taxes for qualified medical expenses, and under IRS rules, amounts you pay to prevent and treat dental disease count. Cleanings, fillings, crowns and gum treatment fit there. For anything mainly cosmetic, ask your plan administrator first.

For larger treatment plans, Cherry lets you split the cost into monthly payments. You can combine all three: insurance benefits toward what the plan covers, an HSA or FSA card for qualified care, and Cherry for the rest.

No dental insurance? The Smile Wellness Membership

If you don't have dental insurance, the Smile Wellness Membership gives you a set yearly plan for preventive care. There's a $189 activation fee, then one of three monthly levels:

• Essential Care, $45 a month: 2 preventive wellness visits a year, digital imaging as needed, 1 to 2 doctor exams, 1 emergency exam and 10% off other treatment.
• Enhanced Care, $59 a month: 3 wellness visits a year, gum-focused maintenance as needed, 1 to 2 exams, 1 imaging session, 1 emergency exam and 10% off.
• Advanced Wellness, $72 a month: 4 precision wellness visits a year, advanced care for plaque buildup and gum inflammation, 1 to 2 exams, 1 imaging session, 1 emergency exam and 10% off.

The 10% off has some exclusions. Your whole family can join on one account, membership starts right after payment, all major debit and credit cards work, and you can cancel in the member portal.

Four questions to ask your plan before your visit

A five-minute call to the number on your insurance card saves surprises later. Ask:

• Does my plan include out-of-network dental benefits?
• What percentage does it pay out of network for cleanings, fillings, crowns and gum treatment?
• How much of my yearly maximum is left?
• Are there waiting periods for crowns or other larger treatment?

Bring the answers with you, and we'll fit your plan's benefits around the treatment your mouth needs.

Start with your mouth, then use your benefits

Insurance is a way to pay for care. At our practice, the plan comes from your gums, your bite and your whole-body health, and then we help you use every benefit you have toward it. You can read more about our practice and how I work.

Your consultation is free. Book a consultation or call (214) 295-9270, and bring your insurance card. We'll take it from there.