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Insurance and Compliance FAQ

Insurance and Compliance FAQ

What does fee-for-service mean at Toothpillow?

Fee-for-service at Toothpillow means that payment is required at the time services are rendered. This model is applicable to our virtual consultations and treatments, offering a modern approach to dental care.

Can I use teledentistry services from Toothpillow in any state?

Most states and countries allow Toothpillow’s teledentistry services, except for Kansas and Georgia. For these states, we can do our best to coordinate care with a local Toothpillow-affiliated dentist for in-person services.

How does billing work if Toothpillow does not offer third-party billing?

After services are rendered, you will need to contact your Toothpillow Treatment Coordinator for a detailed invoice, which you can then use to submit a claim to your insurance company on your own. We cannot assist you with this process.

Will Toothpillow help me with the insurance billing process?

While Toothpillow does not directly bill insurance or communicate with insurance policies, we can provide some guidance on aspects of the dental billing process and assist you with obtaining some documentation for you to claim possible insurance reimbursement.

What should I know about my insurance benefits before seeking treatment?

If you want to pursue a possible reimbursement after services have been rendered, It is important to understand your dental insurance benefits, especially regarding orthodontic coverage. We cannot provide a verification of benefits.

What should I do if my treating provider does not participate in insurance billing after services are rendered?

If your treating provider does not participate in insurance billing, please be aware that Toothpillow cannot directly intervene. Our providers, who are independent contractors, choose their own billing practices. However, we value their participation in our Toothpillow network as they enable us to offer specialized virtual services. In such instances, we recommend discussing alternative payment options with your Toothpillow Treatment Coordinator, who may assist you in exploring other feasible solutions to manage your dental care costs effectively.

How long does the insurance claim process take?

The process of claiming insurance, on your own, can vary and may take some time. Toothpillow appreciates your patience as we try and work with you to gather the necessary information so you can submit your claim to your insurance.

What are Toothpillow’s future plans regarding insurance billing?

Toothpillow is actively working towards integrating third-party insurance billing services to enhance convenience for our clients. Our goal is to eventually offer this service to all Toothpillow clients, simplifying the payment process.

Who should I contact if I have questions about billing or my treatment?

For any questions or concerns regarding our services, billing practices, or other aspects of your experience, please contact our compliance team at . Please allow 24 to 48 hours for a response.

What should I do if I need a detailed invoice for insurance purposes?

If you require a detailed invoice for personal insurance purposes, please inform your Toothpillow Treatment Coordinator immediately after your services are rendered. They will direct you to our compliance department for additional assistance.

Can I receive services virtually for dental code D8210?

It is advisable to verify with your insurance provider whether virtual services billing with code D8210 is permissible. Please note that an in-person visit to the dental office may be required for the assessment and fitting of the removable appliance.

What is the fee for service for code D8210?

The fee for service for code D8210 will be determined after the services are rendered.

Is it Toothpillow's responsibility to review my dental benefits for billable codes?

Toothpillow is a fee-for-service provider. Therefore, it is the patient's responsibility to contact their insurance provider to verify if code D8210 is billable under virtual services. Please ensure to cross-verify with your insurance provider and review the policy details to understand the coverage related to code D8210. For any further clarification, feel free to reach out. Thank you for your attention and understanding.
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