Are Dental Implants Covered by Insurance?

I’m wondering if dental implantsare 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 twodone, but I need to know how much to budget for them, so I’m financially setbefore I go in. I do have a good dental insurance plan through my work. It’s aPPO from Delta.

Thanks,

Jordan

Dear Jordan,

The answer to your question is, “yes, no, and sometimes.”That answer has not been particularly helpful to you thus far, though, so let’sbreak 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 yourcosts) or HMO (gives you discounted rates) doesn’t really matter, nor does the insurancecompany matter so much. There are Delta policies that do and do not cover someor all the costs associated with treatment. The benefits you have arenegotiated by your employer. Ergo, large companies usually have a bit morebargaining power and they can sometimes get better policies for their employeesfor less. Small employers can have great policies too, but usually they’reexpected to select from a few pre-determined choices and don’t get to negotiateas much.

Most Insurances Cover Specific Dental Implant-Related Procedures

Rather than cover dental implants asa whole, insurances break them up by individual procedure codes. On the onehand, you may have the initial surgery where the implant is placed, and perhapsadditional codes for bone grafting or other treatments. On the other, you’llhave the final crown which gets placed on top. It’s common for dental insuranceto 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 thesurgical placement. Others may cover things like anesthesia if you see an oralsurgeon for placement. It varies based on the policy too, but it’s worthlooking into or having your office check into, so you can maximize yourbenefits.

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 shortenedto preauth or pre-d. In this document, your dentist will outline what you needdone, 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 evidencefor treatment and what they will/ will not pay towards it or if they needadditional information. In other words, even though you want to know how muchmoney to set aside before going in, you should actually go in first to get anestimate based on your individual needs and the specifics of your policy.

This blog is sponsored by Elgindental implants provider Dr. Steve Sirin.