Arestin is a popular antibiotic treatment for periodontitis disease. If left untreated, it may cause tooth loss. However, it surprises people when they listen to the fact that numerous insurance companies do not offer coverage for Arestin, despite its effectiveness, for various reasons. For detailed reasons, check out our article. However, coverage depends on many factors, including the patient’s policy.
Arestin’s cost without insurance coverage can create a substantial barrier for patients trying to manage their condition and maintain good oral health. You are not alone; many people are facing this burden.
One common reason for not giving coverage is that if they find that Arestin doesn’t bring significant benefits compared to other treatments that are similarly priced or less expensive, they might decide not to include it in their coverage. Other reasons for the denial of coverage are listed below in this article.
In this article, I try to provide you with the exact reason why many insurance providers do not cover Arestin. For other information, check below.
What is Arestin?
Arestin is a prescription antibiotic drug commonly used to treat periodontal disease (gum disease) with the help of scaling and root planing procedures. This medicine is applied to the pockets of gum or teeth to kill the bacteria that cause periodontal disease. Arestin is applied after completing scaling and root planning procedures. Some dentists can complete it in a single visit.
Periodontal disease is an infection of the gums and the surrounding tissues that support the teeth, which later can cause breakdown of the tissues or gums and finally lead to tooth loss.
Arestin helps to prevent to come back this disease again. However, many insurance companies do not include Arestin in their coverage plans.
Placement of Arestin is very easy; just place it in the pocket of your gums or teeth. It usually takes 1-2 minutes; it does not require any bandages or things to cover up. After some time, it automatically gets absorbed directly by the gums; there is no need to remove anything after taking Arestin treatment.
Arestin, with scaling and root planning procedures, is proven to be an effective solution for fixing periodontal disease.
General Instructions for best result of Arestin
Below are the common instructions that you can follow for the best result of arestin. The rest of the instructions, you can ask from your dentist.
Up to 1 week –
- Don’t touch the site of treatment.
- Brush regularly.
- Avoid eating hard, crunchy, or sticky foods.
Up to 10 days –
- Avoid using commonly used tools like – floss, dental pick.
- For proper healing process, keep good daily routine.
Note:
- It is not recommended to use Arestin for pregnant or breastfeeding women.
- Arestin should only be used if it is recommended by your dentist or doctor.
- If you have an allergy or sensitivity to minocycline or any other tetracycline antibiotic, do not use Arestin.
- Must follow the instructions of your dentist after getting Arestin treatment, like what to eat, how to eat, etc.
Why does it generally occur? Common causes
- Not cleaning your teeth by brushing and flossing often.
- Smoking
- Genetic: transferred from its parents. You have not made any kind of mistake from your side. Its genetic.
- Diabetes or other medical conditions.
- Poor diet. Results in poor nutrition.
- Difficult to clean teeth due to misaligned or crowded teeth.
Why Arestin generally not covered by insurance?
- Type of plan that patients have: Benefits can vary depending on the type of plan you have. Some insurance providers may cover, some may not.
- The insurance company selected an alternative treatment: As you know, arestin is comparatively more costly than the other available alternatives for the same treatment (for periodontal disease management). Some insurance providers view these options as an alternative that is cost-effective and less risky than Arestin.
- Examples –
- Scaling and root planing procedures
- Other oral antibiotics
- Good oral hygiene practices Insurers
- etc.
- That’s why the insurance company provides coverage on the alternative of Arestin, which comes at a lower price, and not on Arestin.
- Examples –
- Cosmetic procedure: Some insurance providers may categorize Arestin as non-essential or cosmetic rather than a medically necessary treatment. That’s why it’s typically not covered by insurance.
- Lack of clinical evidence: conflicting studies on antibiotic treatments for gum disease, including Arestin, make it challenging for insurance companies to justify coverage. Recent studies say some individuals are experiencing little improvement, some are not, and some are worse. However, research is still ongoing for the effectiveness and safety of arestin. If medication seems expensive and has less medical evidence, insurance providers generally do not provide coverage for it.
- Lack of Long-Term Data: Compared to other periodontal treatments, there is less data on their effectiveness.
- Lack of Awareness: Some insurance providers may not be fully aware of Arestin’s benefits.
However Contact your insurance provider directly: Contact your dental office to discuss your insurance coverage for Arestin. They will help you determine your eligibility. Copay could be as low as $0 if your plan makes you eligible. If your insurance doesn’t cover ARESTIN, talk to your dentist about other treatment options available to manage your periodontal disease.
Related Article: – is oral surgery covered by blue cross blue shield?
Tips for the appeal process
If your insurance company denies coverage, you have the right to appeal the decision. The appeal process typically requires documents from the healthcare provider. In documentation, your health care provider writes a formal letter with additional documentation to the insurance company in which they include justification, medical records, and reasons why the treatment is necessary.
Getting coverage is a little bit difficult, but with proper documentation and support from healthcare providers, you can get coverage for Arestin.
Step-wise strategies that you need to keep in mind. Rest at every step; your dentist may help you.
- Gather supporting evidence and additional evidence, such as medical records, that support the necessity of the Arestin treatment.
- Consult a dental professional. A dental professional can provide you with valuable information about your insurance plan, and they can help you at every step of the appeals process.
- Letter of Medical Necessity and Justification: Gather a formal letter, often written by the healthcare provider, explaining the medical reasons behind the recommended treatment and highlighting its importance for your health. A clear and detailed explanation is also written in the letter—why the specific treatment or service is necessary for the patient’s health.
- Gather relevant research studies supporting the effectiveness of Arestin.
- Gather pre-authorization (if available) documentation that you have already obtained from your dentist.
- Gather all other strong evidence and documentation that helps to create a strong case.
- File your appeal –
- Contact your insurance company to understand their unique appeal procedures and deadlines.
- Submit a formal appeal letter clearly outlining – request for coverage reconsideration.
- Attach all the gathered supporting documentation to your appeal letter.
- Submit your appeal within the timeframe to prevent any potential delays.
- Be connected to the insurance company and dental professionals; they may request additional information.
Additional Tip:
- You can join patient advocacy groups. For more information, you can check it out on Google.com.
- Consider consulting a healthcare advocate or attorney experienced in insurance appeals for guidance and support.
Alternatives of Arestin
Ask the dentist; they will suggest the best alternative according to the condition of your teeth. However, these are some alternatives you can keep in mind.
- Scaling and root Planing (SRP) is a non-surgical procedure used to remove plaque and tartar from the teeth and root surfaces. It aims to reduce inflammation and promote the healing of the gums.
- Systemic antibiotics: These are taken orally and can be effective in reducing inflammation and bacterial infection in the gums. Common systemic antibiotics are – amoxicillin, metronidazole, and doxycycline.
- Local antibiotics: These are delivered directly to the affected areas in the gums through gels, chips, or mouthwashes. Examples are PerioChip and Atridox.
- Laser therapy: Laser therapy involves the use of lasers to target and eliminate bacteria in the gums. This can be a less invasive alternative to surgery and can effectively reduce inflammation and enhance gum health.
- Oral Hygiene Education: Consistent oral hygiene habits, such as regular brushing, flossing, and routine dental cleanings, play a crucial role in preventing and managing periodontal disease.
- Surgical procedures: In severe conditions, surgery may be necessary to remove infected tissue and reshape the gum and bone around the teeth.
- Natural Remedies: Some natural remedies and herbal supplements can be used for the management of periodontal disease. Consult with your dentist before using any natural options.
- Other options:
- Oil pulling: This involves swishing oil in your mouth for several minutes to remove bacteria.
- Saltwater rinses: This can help to reduce inflammation and pain.
Cost of Arestin? (Without insurance)
Arestin is a non-surgical procedure and significantly more expensive than other treatment options.
Scaling and root planing procedures can also add additional costs because arestin treatment is commonly used after scaling and root planing procedures. The cost of scaling and root planing is around $100 to $300 or more.
On average, Arestin alone costs around 30-100$ per site without insurance. However, the price can vary according to many factors, like number of teeth, , condition of your teeth, location of the office, insurance plan you have, etc.
Conclusion
Arestin is generally not covered by the insurance provider due to many reasons; however, you can file a claim for coverage; if your claim gets approved, it’s good; if denied, you can still appeal the denies; there will be a chance of getting approval. If your claim is still not approved, consider alternative treatments and other payment options for periodontal disease. However, you can discuss with your dentist, for this matter, what to do and what not to do. They can give you the best decision according to your condition.
FAQ
Q. How is arestin effective?
According to some studies, Arestin is more effective for reducing pocket of gum and overall tooth health when used with SRP (scaling and root planing )
Q. Has the insurance provider ever covered Arestin or always denied it?
In general, Arestin is not covered by an insurance provider, but that does not mean it is always excluded by the provider. In some cases, insurance companies may cover Arestin if specific criteria are met; it actually depends on many factors, including the individual’s policy plan, medical necessity, etc.
Q. What is the cost of Arestin without insurance?
Arestin treatment works with the SRP procedure (scaling and root planing), so the price of Arestin alone is around – 30-100$ per site. The cost of scaling and root planing is around $100 to $300 or more. Overall, the sum of both is around 200–400 dollars; however, prices can vary depending on many factors and different situations.
Q. Are there any patient assistance programs for Arestin?
Yes, there are several patient assistance programs available to help with the cost of Arestin treatment. They may offer financial assistance, discounts, or coupons to eligible patients who meet specific criteria, such as income levels, lack of insurance coverage, etc.
Q. Does the insurance provider pay for ARESTIN?
Yes, but it depends on many factors. such as the type of plan, individual condition,etc.
Q. How is Arestin is different from antibiotic pills?
Antibiotic pills are taken orally and circulate throughout the entire body. These are distributed throughout the body, reaching various organs and tissues, not specifically targeting the gums. On the other hand, ,Arestin is site-specific, applied locally, directly into the periodontal pockets; however, for this treatment, it requires dental professionals.
Q. Can I use my FSA or HSA to pay for Arestin?
Yes, you can use your Flexible Spending Account (FSA) or Health Savings Account (HSA) to pay for Arestin treatment, but make sure Arestin is an eligible expense according to the guidelines of your FSA or HSA plan.
Q. Are there any dental discount plans that cover Arestin?
Yes, for more information, you can contact your dentist.
Q. Can I negotiate the cost of Arestin with my dentist?
Yes, why not? They also provide you with many other options, and by using them, you can save money.
Q. How can I know if my medical insurance provides coverage for ARESTIN?
Check your insurance plan. Contact your insurance provider; contact the dentist where you go for treatment. Overall, contact the dental office where you go for treatment; they will manage the necessary paperwork to determine whether your medical plan covers ARESTIN. If your insurance provider provides coverage for ARESTIN, you may be eligible for a copay as low as $0.
Q. What should I do if I don’t have any insurance coverage for Arestin?
Contact your dentist; they will suggest many options for saving money.