How to Get Dental Implants Covered by Medical Insurance
How to Get Dental Implants Covered by Medical Insurance Dental implants are expensive despite the fact that they are a long-term solution for missing teeth.
Medical insurance may pay under certain conditions, although the majority of dental insurance plans consider implants a cosmetic procedure and deny paying the full cost.
This article explains how to maximize your benefits, eligibility factors, and medical insurance coverage for dental implants.
Medical Insurance Coverage: Dental Implants Upon
Dental implants are typically paid for by medical insurance when they are medically necessary. Medical insurance can be helpful in several circumstances as follows:
Trauma or Accident
The medical insurance can cover dental implants under reconstructive surgery if tooth loss is caused by an accident, injury, or facial trauma.
2. Congenital defects or birth conditions
Some conditions, such as cleft palate, ectodermal dysplasia, or loss of teeth caused by a genetic disorder, may be covered by the health insurance.
3. Active Disease or Infection
Health insurance covers implants as a treatment option when you lose teeth because of an oral infection, cancer, or any other serious disease.
4. Jaw Repairing Surgery and Bone Loss
If reconstruction of the jaw or bone grafting is needed before the implants can be inserted, your medical insurance may cover these, which will lower the cost of the implants.
Steps to Get Medical Insurance for Dental Implants
First step is: Review Your Medical Insurance Policies
See how dental work is handled under your health insurance policy.
Look for keywords like “oral surgery,” “accident-related dental work,” or “reconstruction.”
Second: get a medical diagnosis.
Go to your primary care doctor and dentist to get a medical diagnosis describing the need for implants.
Have your problem documented in medical, not dental-only, terms.
Third step: arrange a preauthorization.
Ask your dentist or oral surgeon to send a preauthorization request to your medical insurance.
Medical records, X-rays onward, and supporting documents explaining why implants are vitally important to your health.
Step four is where medical billing codes are applied.
Confirm that your provider uses medical insurance codes (CPT codes) instead of dental codes when submitting claims.
Some of the relevant rules are:
D6010: implantation procedure
D6105: Bone grafting
D6190: Radiographic examination
Fifth step:
rejected appeal file
If your claim is denied, ask your insurer to give you a written explanation.
Appeal with more medical rationale in conjunction with your dentist.
Find out if Medicare, Medicaid, or a secondary insurance policy covers you if your primary medical coverage does not cover implants.
The seventh step
is where research on multiple payment options comes in. Utilize a Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay a portion of the bills. Look for dental discount plans or other payment options from local dentists’ offices.
First question: Does Medicare cover dental implants?
Medicare won’t typically pay for dental implants unless they’re part of a medically necessary procedure such as cancer treatment or reconstructive surgery after trauma.
2. Will Medicaid pay for dental implants?
State by state, Medicaid coverage varies.
Most governments pay for implants for medically necessitated procedures such as jaw reconstruction or serious oral disease.
How much do dental implants cost without insurance?
The average price of a single implant with the procedure and implant crown ranges from $3,000 to $6,000.
$20,000 to $50,000 are the potential costs of full-mouth implants.
Should I pay for dental implants using an FSA or HSA?
Absolutely!
Pre-tax dollars paid for implants allow FSAs and HSAs to lower your out-of-pocket expense.
