Dental Implants & Insurance Coverage

By: EON Clinics Staff

Published: 09/16/2016

 

Are you interested in getting dental implants but you’re not quite sure how you can pay for it? The dental implant procedure is the most natural treatment you can receive for tooth restoration.  We completely understand being cautious about pricing, here are  a few of our most frequently asked questions about  dental implant pricing, insurance, financing, and the consultation. In order to decipher how much your dental implant treatment will cost, a doctor will need to evaluate your gum and the bones. EON Clinics offers a complimentary consultation that further explains how dental implant treatment options are priced after a 3D CT scan is conducted and examined by the prosthodontist. With the conclusion of the 3D CT scan, the doctor will provide treatment options and a quote.

Dental Implants and Insurance

Is dental implant treatment covered by dental insurance?

Insurance coverage of implant treatment depends on the individual policy. However, it is rare to receive any substantial coverage. Since the benefit coverage is determined strictly by the amount the employer wants to spend on the policy, and the insurance companies want to build in their profit margins, there are major limitations on most dental insurance plans. In reality, the plans are only designed to cover routine maintenance, emergencies and basic care.

The insurance companies use statistical data to determine the most common procedures submitted on claims, and then they set their own usual and customary fee schedule for these procedures. They also determine the specific restrictions and limitations for each plan. Because the plans are only intended to cover the basics, there is an annual maximum allowable benefit of $1,000-$1,500 on most plans.

Although most companies exclude implants as a covered benefit, many of them will pay the same benefit they would cover for the lowest cost alternative treatment option (partials and dentures) and some of the diagnostic records, if a specific request is made for alternative benefits. Even if an individual policy includes implants as a covered benefit, the amount of coverage is still limited to the annual maximum allowable.

Does medical insurance cover implant treatment?

 

There are a few cases where medical insurance is available for people who are missing all of their teeth, and as a result, have medical complications. This type of coverage depends solely on the individual policy. Other than these situations, medical coverage is very rare.

Work related injuries and other types of accidents are the other cases that are sometimes covered by insurance. Medicare does not cover implant treatment. All in all, it is best to assume that there is no medical insurance coverage available.

Are any surgical procedures covered under medical benefits? My dental benefits are limited to $1,500.00 per calendar year.

Typically, medical insurance will cover implant/tooth replacement procedures related to the following types of conditions:

  • trauma, say you lose your front teeth after a car accident
  • loss of teeth due to a medical condition
  • if teeth are lost in the course of tumor treatment
  • a congenitally missing tooth

Are anesthesiologist's fees billable to medical insurance?

At EON Clinics the oral surgeon administers the anesthesia, which is included in the fee.

Does Insurance Cover Dental Implants?

The dental implant procedure is an elective procedure that is not covered by state funded insurance. Certain insurances may have an elective amount that  can be utilized for dental implants; however, that payment will be paid back in the form of a reimbursement to the patient.

Financing Options for Dental Implants

Working with EON Clinics we offer financing through two third party companies, Care Credit and Lending Club. Both companies partners with us to provide financial assistance to our patients and allows them to pay a monthly affordable rate for their dental implant procedure. If you have a family member or loved one who would like to apply for financing on your behalf for your dental implants, we will be able to accept their application upon approval from Care Credit or Lending Club.

What happens during the consultation?

The consultation works as a great informational session to provide specific case information to the patient in question. After a 3D CT Scan, the Prosthodontist will sit down and discuss potential dental implant treatments that will be suitable to your needs. After sitting with the Prosthodontist, our treatment coordinator will discuss the pricing of your treatment and financing options.

Dental implants are an investment for your overall health. If payment is an issue call us today or schedule a free consultation online, we have multiple financing options.