Monday, August 27, 2012

Does Insurance Cover Dental Implants?


Dental Implant Insurance Coverage

In general, dental implants are not covered by dental insurance at this time. Coverage under your medical plan may be possible, depending on the insurance plan and/or cause of tooth loss. Detailed questions about your individual needs and how they relate to insurance will be discussed at your initial consultation.
Dental insurance is a benefit negotiated by the insurance company and usually your employer. In that negotiation, reimbursement for dental implant surgery, implant abutment, and implant crown may or may not have been included in the plan. You would be best to ask your HR department or to call your insurance company to find out what your coverage is and at what reimbursement level. Many dental policies only cover $1000 per year, so even if you stretch the treatment over two policy years you will have to some out of pocket. And always remember that insurance companies make money by NOT paying out on claims, so expect them to drag their feet. We enter the claims electronically and we can often get an estimate of  your benefits quicker, so you can have an idea of what you will have to pay out of pocket at your initial consultation.

Medical Cross-Coding

Over the years, changes in dentistry have appeared to come slowly, with many practices unable or unwilling to stay abreast of important advances in technology, including billing practices and expertise. However, Dr. Golpa has devoted his career to integrating the latest, most innovative of these advances into his practice. Patients benefit from medical cross-coding because of the more favorable copayment terms offered by the average medical insurance. Typically dental plans will cover 50% of the procedural costs. Most medical plans offer a more generous copay, with 80% of reasonable and customary charges being common. We can offer patients that level of savings on major procedures that are more likely to be medically sensible decisions, like the "all-on-4 Dental Implants Procedure.
Medical cross-coding, as it is called, lets us bill medical insurance for certain procedures such as:
  • Oral surgical procedures
  • Medically necessary implant procedures
  • Medically necessary periodontal procedures
  • Medically necessary laser procedures
  • Consultations and examinations for orofacial medical conditions
  • TMJ procedures
  • Procedures associated with oral dysfunction
  • Dental procedures related to trauma
  • Screenings for oral cancer
  • Dental procedures for myofascial pain conditions
  • Sleep apnea procedures
  • X-rays, including medically necessary CT scans associated with the procedures above
Most dental policies have a limited yearly benefit, while medical policies typically have annual deductibles. Once the deductible is satisfied the plan will continue to pay benefits unless the patient reaches a lifetime maximum benefit. When we bill the medical insurance for oral health procedures that are medically necessary it leaves the dental benefits available for non-medical procedures. This advantage cannot be overstated when you consider that an average dental plan may only pay $1,500 in dental benefits, which can easily be consumed in a single root canal or crown. 

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