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:

  1. Trauma - say you lose your front teeth after a car accident
  2. Loss of teeth due to a medical condition
  3. If teeth are lost in the course of tumor treatment
  4. 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.