Is sedation dentistry covered by insurance? It’s a question the team at Specialty Dental Care has heard numerous times during our many years serving Omaha and surrounding cities.
What are the benefits of sedation dentistry?
Sedation dentistry is a big help for Specialty Dental Care patients who require important dental care but have difficulty overcoming anxiety or a phobia related to receiving this care while awake. In other instances, patients with certain medical or mental conditions may also need sedation during dental work in Omaha.
Is sedation dentistry covered by insurance?
In most cases, the answer is no. A standard dental plan does not cover sedation dentistry expenses, despite its proven benefits for millions of Americans. Insurance companies put sedation dentistry into the same group of “non-essential dental procedures” occupied by “luxury” treatments like dental implants and cosmetic surgery. Like dental implants and cosmetic surgery, sedation dentistry carries a high cost, especially when a patient requires deep sedation or general anesthesia. In some areas of the country, and depending on the type of dental treatment being administered, the cost of sedation may equal or exceed the cost of the overall treatment itself. Thus, insurance companies argue that covering sedation dentistry would necessitate higher premiums.
Instances where sedation dentistry could be covered by insurance
The most common instance in which an insurance company will cover sedation dentistry is a situation in which the use of sedation actually lowers the cost of the overall dental treatment. In these cases, an insurance company may cover some or all of the sedation-related expenses.
If treatment must be delayed, or spaced out in intervals due to anxiety, sedation may be a good option with chances of insurance coverage increasing. An insurance company will likely cover the required sedation – especially if its administered in nitrous oxide form and not intravenously, which is more expensive.
Another example in which an insurance company will pay for sedation dentistry is if the patient has a serious medical condition or disability that makes it impossible for them to receive dental care without sedation. This applies to disabilities/conditions such as cerebral palsy, autism, mental retardation, and epilepsy.
A third scenario in which insurance may cover sedation dentistry is when the dental procedure is exceptionally complex, i.e. major oral surgery or multiple tooth extractions. This doesn’t apply to treatments like root canal therapy and fillings, as insurance companies consider these to be “routine treatments”.
What to do if your insurance company refuses to cover sedation dentistry
In the event that your insurance company refuses to cover sedation dentistry, you have a few options. One is to seek out a special policy that will cover sedation dentistry, but at a higher premium. Another option is to talk with your dentist about financing options and payment plans. A third route is to connect with a third-party financing provider.
Contact Specialty Dental Care in Omaha for more information about sedation dentistry and whether your insurance will cover it.