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ViziLite Plus Insurance Coverage

ViziLite Plus Insurance Coverage

Your medical and dental insurance benefits should not dictate the standard of care that you receive from a dental professional. This is especially important for screening procedures, such as the ViziLite Plus examination. Dentists that offer ViziLite Plus exams to their patients want their patients to receive the highest quality standard of care available.

Dental Insurance

The American Dental Association has established a dental insurance procedure code that applies to the ViziLite Plus exam. This code is the CDT-5 D0431 code. Be sure to verify that your dentist has submitted a claim for this specific procedure and code. Your dental plan may cover this procedure and both you and your dentist may not be aware of it.

Medical Insurance

Your medical insurance company may also cover the ViziLite Plus exam. There are medical insurance codes that have also been used to obtain insurance reimbursement for the ViziLite Plus exam. These codes are CPT code 82397 for "chemiluminescent assay" and ICD-9 code, V76.42, which refers to a “special screening for malignant neoplasms, oral cavity”. Either you or your dentist can submit medical claims to your medical insurance company. Your medical insurance company can provide you with a claim form.

MSA/HSA Option

Medical Spending Accounts or MSAs, if offered by your employer, are an excellent option to use for reimbursement of your ViziLite Plus examination. Healthcare Savings Accounts, HSAs, can also be an option for reimbursement of your annual ViziLite Plus exam. In any case, be sure to get documentation of the ViziLite Plus exam from your dental office and submit a copy of this, along with your receipt, for reimbursement.

What if my claim is denied?

Zila Pharmaceuticals has also prepared sample appeal letters for you to send to your insurance company in the event that your submission for reimbursement has been denied. Simply download the letter (or request a letter by calling 866.945.2776), add your information to the letter, and forward it to your insurance company.

Other important considerations

It is also strongly recommended that you communicate to your employer the importance of the ViziLite Plus examination. Then ask whether your employer's dental and/or medical benefits cover the ViziLite Plus exam. Your input is very influential with your employer and could influence the coverage decisions that are made in conjunction with your employer's dental and medical insurance companies. If you prefer to send a letter to your employer, download a letter template, add your information, and then forward to your employer.

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Endre Selmeczy DMD
489 N L St, Livermore, CA 94551