Dental insurance should cover my dental implant cost…right?

By Anthony Lieu, DMD

If you’re thinking about getting a surgery for dental implants, a definite consideration is the dental implant cost.  Click Here to see our quiz if Dental Implants are the right option for you. The average working person with dental insurance has a plan with Cigna, Delta Dental, United Concordia or one of the thousands of plans out there. If you have  dental insurance, that does not mean that your insurance policy will cover the dental implant cost of the surgery or the restorations. More and more dental insurance plans are covering procedures like implants. If you’ve never had occasion to find out before, call your insurance provider and just ask them. They will be happy to help you out.

However, there are also some tricks that insurance companies are doing that mislead people looking for dental implants. One we have seen several times, are companies that offer a supplemental plan to cover things like Implants, dentures, root canals, etc. To the average person, these plans sound great. Low monthly cost for what looks like it will cover most of the cost for those higher priced procedures. Unfortunately, most people do not read the details of the policy that explain the limitations. Usually these plans have a few common “tricks.”

Waiting periods

The policy will only cover the treatment after you have been paying into it for a set period of time. That can be anywhere from 3 months to an average of one year.  Rare cases can be five years! Why pay for something you can’t use for five years! For what you would pay monthly in premiums, you could pay for your dental implant cost of surgery 2 or 3  times.

Fee Schedules

The policy will cover a certain amount of the treatment, per their set fee schedule. They may say the plan covers up to a certain cost for the dental Implant placement, but what really happens is they cover a portion of the cost that the insurance plan determines, not the fee that the dental office charges. Patient ends up paying the difference and sometimes the fees are so low that the Dr. is barely even able to cover the cost of materials for the implant surgery.

“Cheapest option” clause

There is not really a place in any insurance policy that calls itself cheap, but what we sometimes see is that some policies will cover the treatment for a lost tooth, but it must be the cheapest option. A more affordable and long lasting option that is covered is a partial. However many people want implants because they are permanent and look like natural teeth. A bridge can cost as much as a dental implant and healthy teeth may need to be drilled on to attach a bridge. The insurance policy will cover up the cost of the cheapest option, instead of what the implant would cost. Dental Implant cost is more, so the insurance prevents patients from even considering them as an option. Patients end up having to pay more in that case, or settle for something that they really don’t want.

We also often see people buy dental insurance as an individual thinking it will save them money for treating cavities or crowns. HMO insurance is more affordable, but you must go to whoever is signed up with the HMO plan. Patients often have few choices and most of the options are in a clinic type setting. That means less attentive care and a “Greet ’em and Street ’em” experience.

PPO plans give more freedom of choice for provider. Sometimes PPOs will have fee schedules. Sometimes people with PPO plans can go “Out of Network” and pay similar cost for copays as if they saw a provider in network.

It all gets confusing. We try to help people understand their insurance plans and coverage and can always provide an estimate of cost, but it is difficult to know exactly what the final “Out-of-pocket” expense will be.

Sometimes it is more cost effective to pay cash or use a financing company like Care Credit. We also have many of our dental implant patients sign on with Plan for Health which gives an additional 10-15% discount with membership.

Megan and Karen know much more about insurance plans and can help with any questions you may have about getting coverage to help you pay for the dental care you need.

Be Well!

Dr. Lieu