I’m wondering if dental implants are covered by insurance. I keep finding conflicting information on it. Some say yes, others say no, and others say sometimes. I’d like to have two done, but I need to know how much to budget for them, so I’m financially set before I go in. I do have a good dental insurance plan through my work. It’s a PPO from Delta.
The answer to your question is, “yes, no, and sometimes.” That answer has not been particularly helpful to you thus far, though, so let’s break things down a bit and explore ways for you to get a more definitive answer.
Every Insurance Policy is Different
Whether the insurance is a PPO (pays a portion of your costs) or HMO (gives you discounted rates) doesn’t really matter, nor does the insurance company matter so much. There are Delta policies that do and do not cover some or all the costs associated with treatment. The benefits you have are negotiated by your employer. Ergo, large companies usually have a bit more bargaining power and they can sometimes get better policies for their employees for less. Small employers can have great policies too, but usually they’re expected to select from a few pre-determined choices and don’t get to negotiate as much.
Most Insurances Cover Specific Dental Implant-Related Procedures
Rather than cover dental implants as a whole, insurances break them up by individual procedure codes. On the one hand, you may have the initial surgery where the implant is placed, and perhaps additional codes for bone grafting or other treatments. On the other, you’ll have the final crown which gets placed on top. It’s common for dental insurance to cover the crown on top, but not all will cover the surgical placement.
Your Health Insurance May Cover Some of the Expenses Too
Some, but not all, health insurance companies will cover the surgical placement. Others may cover things like anesthesia if you see an oral surgeon for placement. It varies based on the policy too, but it’s worth looking into or having your office check into, so you can maximize your benefits.
Have a Pre-Authorization Done to Get Solid Numbers
Offices can send your insurance companies what’s known as a pre-authorization or pre-determination, sometimes shortened to preauth or pre-d. In this document, your dentist will outline what you need done, why it needs to be done, provide supporting evidence of your condition (such as x-rays and notes), and list the costs associated with each procedure. From there, the insurance will send a note back saying there’s sufficient evidence for treatment and what they will/ will not pay towards it or if they need additional information. In other words, even though you want to know how much money to set aside before going in, you should actually go in first to get an estimate based on your individual needs and the specifics of your policy.
This blog is sponsored by Elgin dental implants provider Dr. Steve Sirin.