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dental implants insurance coverage

Dental Implant Insurance

Having dental implant insurance is the best way to reduce the amount you have to pay for replacing missing teeth with dental implants. When talking about dental implant insurance, we refer to dental insurance that covers the cost of both the surgical and restorative phase of dental implants or at least a good part of it.

Does Dental Insurance Cover Dental Implants?

Dental implants provide excellent results for replacing missing teeth but they are a very expensive treatment. With a minimum cost of $1,000 (and $3,000 on average) many patients who have lost a tooth or more due to an accident or periodontal disease are unable to get the benefits of dental implants because they can not afford the cost.

In general, implants are not covered by dental insurance. Coverage under your medical plan may be possible, depending on the insurance plan and/or cause of tooth loss.

Implants are usually more expensive than other methods of tooth replacement, and most dental insurance providers typically cover none or less than 10 percent of the treatment fees.

Do You Have Dental Implant Insurance Coverage?

You must be aware that having a good dental insurance does not guarantee that you have any coverage for getting dental implant surgery. Various terms may exist in your dental insurance policy that exclude dental implants either directly or indirectly. You may be certain that you have dental implant insurance coverage only if dental implants are stated clearly in your policy as a covered treatment. You should always research your dental implant insurance coverage before deciding implant surgery, unless you are prepared to cover the costs yourself.

The following terms may exclude dental implants from your insurance coverage:

  • often it will be directly stated in the policy that dental implants are not covered
  • existing conditions - many insurance policies will not cover you for the cost to treat conditions such as a missing tooth that were pre-existing at the time of signing your policy.
  • cosmetic procedures exclusion - unfortunately dental implants are considered as a cosmetic procedure even though they provide functional benefits to the patient additional to the aesthetic ones. A common term in most dental insurance plans that cosmetic treatments are not covered might also exclude dental implants from insurance coverage.
  • L.E.A.T. - another common term is that of the "least expensive alternative treatment". LEAT clause means that dental insurance will not pay you for the full cost of dental implants because there is an acceptable alternative treatment that is less expensive such as a bridge or a regular removable denture. Even if the provider accepts to cover the treatment, dental insurance coverage is normally not more than the cost of the alternative treatment.
  • waiting time - when obtaining a new dental insurance you must usually wait for at least a year before having any serious dental work, or even more for expensive treatments such as dental implants.

If any of the above terms appears in your dental insurance policy, it is highly possible that you will have to pay the full cost of dental implants on your own (or at least the bigger part of the cost).

It is very important to check your policy and find out if you actually have dental implant insurance coverage before planning any implant surgery, unless you are able to pay for the full dental implant cost from your own family budget.

How to get some benefits for dental implants from dental insurance

In some case it is a mistake made by dentists and patients who do not submit claims for any of the treatment costs because they assume incorrectly that a dental insurance plan does not reimburse any implant costs at all when there may be some benefit available.

• Partial coverage of restorative phase

Although your dental insurance plan might not cover dental implants, it might still possible to get some level of reimbursement for your dental implants expenses. Many insurance policies exclude the costs of the implant placement (surgical phase) but may cover some of the costs associated with the restorative phase as part of the plan's prosthetic coverage. In this case the dental insurance will provide reimbursement for restoring the implant with a crown in a manner similar to that in which natural teeth are restored.

• Specific case coverage

Some dental insurance providers will accept to cover the cost of dental implants in certain cases only. The most usual case covered is that of a single implant used instead of a three-teeth bridge. The cost of dental implant in this case is not significantly higher than the bridge, and the long term potential costs for the provider may be actually lower if the implant is preferred.
See also: Cost comparison - Dental Implant Crown vs Three-Unit Bridge

To receive the maximum reimbursement, the implant dentist must follow carefully the procedures outlined by the insurance provider and be clear about the case and the need for implant restoration. If the dental insurance provider's claims reviewer is clear about the need for the treatment and the appropriateness of the case, many insurance companies will provide some benefit at least for the restorative part of treatment. Dental implant insurance coverage is the only way for many patients to handle the expensive dental implant treatments and improve their quality of life for the rest of their lifetime.

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Last update: 03/03/2014