Understanding health insurance and dental coverage can be tricky, especially when it comes to specialty procedures like dental implants. Many patients ask us if their dental insurance will cover the cost of dental implants, and the answer is that it depends on your insurance and the type of implant you receive. Dr. Mark Sowell of Sensational Smiles in Plano, TX and his dedicated staff will work with you and your insurance company to create a treatment plan that fits both your needs and budget.
Understanding Dental Insurance Coverage
Many insurance providers consider dental implants to be a cosmetic procedure, and therefore not medically necessary. Although this is what many insurers believe, anyone who is missing teeth knows that living with missing teeth can be detrimental to your health, affecting your speech, ability to eat and even your self-confidence.
Covering the cost of your dental implant procedure may require using both medical and dental coverage, depending on the reason you need implants. Teeth lost due to medical conditions or injuries may be more likely to have their replacement implants paid for by insurance than those lost to tooth decay and other dental issues. Review your insurance policy to see if dental implants are discussed. Before having any procedure, it’s important to ask your insurance provider questions about your policy and coverage to ensure there are no unpleasant surprises.
These questions include:
- Does the plan cover implants?
- What percentage of the procedure does the policy cover?
- What is my annual maximum out-of-pocket cost?
- Do I need a referral before receiving dental implants?
The staff at Sensational Smiles will work directly with your insurance company to determine your coverage for the procedure based on the treatment plan created by Dr. Sowell.
Are Implants Covered By My Insurance?
To determine whether your insurance covers implants, it’s important to know the different parts of the procedure and how much preparation is needed. The amount of coverage also depends on whether you are replacing a full arch of teeth or just one or two missing teeth.
Tooth Extraction: Depending on whether you are already missing teeth or if a damaged tooth needs to be extracted and replaced, this procedure may be part of your dental implant treatment. Most insurance companies will cover all or most of a tooth extraction.
Bone Grafting: Some patients with missing teeth may need their underlying jawbone strengthened prior to having the implant placed to ensure the implant will remain securely in place. This part of the procedure may not be covered, despite it being a crucial step in the implant procedure.
Placing the Implant: The implant placement procedure is considered a “major” dental surgery. Don’t be afraid of the word “major,” though — this is a term insurance companies use that does not always reflect the intensity of treatment. Some plans may cover up to 50 percent of major procedures.
Placing the Crown: The placing of the crown — the artificial tooth that provides the appearance and functionality of natural teeth — is also considered a major procedure. However, some plans consider this the same as crowning a natural tooth due to tooth decay and may cover more of the cost, so check directly with your insurance company.
Dental Implants in Plano, TX
We understand that working with your insurance while trying to stay within a budget can be confusing. The Sensational Smiles staff will work with you, your dentist, and your insurance company to offer you the best treatment based on your needs and budget — and a long-lasting smile. Schedule a free consultation online or call (972) 382-6855 today to start discussing how we can help you restore your smile.