Sedation dentistry helps many patients to get the proper dental care they need, overcoming dental anxiety or phobia, and medical or mental conditions that make difficult to get dental treatment without sedation. Unfortunately, sedation dentistry is typically not covered by dental insurance. However, under some conditions you may get some, at least partial, coverage of dental sedation through your medical or dental insurance policy.
Despite the many benefits that dental sedation offers to the dental health of millions of patients, a typical dental insurance does not cover sedation dentistry expenses.
Most insurance policies consider dental sedation as a not necessary procedure for the administration of dental treatment, not providing coverage for sedation dentistry, categorizing it in the same group as luxury treatments such as cosmetic dentistry and dental implants.
The cost of sedation dentistry is considerably high, especially for deep sedation and general anesthesia. In some types of treatments the cost of sedation may even double the cost of the overall treatment. Dental insurance companies prefer to exclude expensive dental sedation procedures from the list of covered treatments, otherwise they should have to increase significantly their fees.
Even if sedation dentistry is not included in your insurance policy, your insurance company may accept to cover some or all the cost in some cases. An insurance company is interested in reducing the overall cost of the treatments that they will have to pay to your dentist. Therefore if the total cost of your dental treatment will be less by using dental sedation, your insurance will possibly be happy to pay for sedation dentistry.
An example case is when you are undergoing periodontal scaling and root planing of all four quadrants of your mouth, which normally requires four appointments; one quadrant is normally treated at each visit. If your dentist can provide dental sedation making the process more comfortable for you, and in the same time allowing him to complete the whole treatment in a single appointment saving on disposables and valuable office time, he may make a significant discount to the cost of SRP. If the combined cost of sedation dentistry and actual treatment when sedated is lower than what it will be if it was performed in four separate visits without sedation, there is no reason for the dental insurance to deny paying for the dental sedation. Getting insurance coverage may be easier for lower cost light sedation using nitrous oxide than for the more expensive intravenous sedation (IV sedation).
Dental insurance plans may cover unconscious (deep) sedation, or general anesthesia, only when it is medically necessary in order to treat a patient. Patients with certain disabilities or medical conditions such as epilepsy, cerebral palsy, autism, or mental retardation, can not receive proper dental care without the help of sedation dentistry.
Many dental insurance companies will cover complicated surgical procedures such as multiple extractions or major oral surgery under IV sedation; however, routine treatments such as fillings and root canal therapy are not typically covered. Depending on the terms of each specific insurance plan, it may cover sedation dentistry for patients diagnosed for severe dental phobia, or when the patient is unable to receive regular dental care due to a disability. Some plans may also cover dental sedation for certain treatments for children under 6 years old.
Even if you get the approval from your dental insurance that sedation dentistry costs are covered by your policy, you should check the other terms of your insurance policy. If your policy has an annual maximum, as most have ranging between $1000-2000, it may be not enough to cover the costs of dental treatment and the additional cost of sedation. In this case you will be again asked to pay the exceeding amount by your own pocket.
Although the general rule is that dental insurance plans do not cover sedation dentistry, there may be ways to have your dental sedation covered under certain circumstances.
Contact your insurance provider prior to your appointment to confirm under which conditions they may cover sedation expenses, or even better ask your dentist’s office to contact them for approval and make the necessary arrangements.
Your sedation dentist must work with you to maximize your insurance benefits. The way each dentist documents a case to your insurance provider may play a significant role in the approval of your expenses for sedation dentistry. Hence, it is advised to have a dentist with enough experience not only in sedation techniques but also in handling insurance claims.
Get details about any related restrictions. Your insurance may have limits on the amount of time, covering only 1-2 hours of dental sedation. Since the cost may be high, it is advised that you get a written approval from your insurance agency before starting treatment.
Having sedation dentistry can eliminate any sense of pain and discomfort during dental treatment, but it can prove to be painful enough when you get the bill from your dentist for the additional costs and you find out that it is not covered by your dental insurance.
In this case, if you absolutely need the help of sedation dentistry to get treatment, you may seek some special policies that can be purchased with a higher premium that will cover sedation dentistry, within limits.
Otherwise you may ask your sedation dentist for a convenient financial arrangement. Your dentist may offer financing options that will make your treatment more affordable, or suggest financing from a third party provider.