Why Dental Implants Are Not Covered By Insurance?

The most likely reason why insurance companies refuse to cover dental implants is that they are in business to make money, not to keep patients healthy. Dental implants are not cheap. The function of dental implants, their attractiveness, their longevity, and their overall impact on quality of life make them a great lot from the perspective of the person receiving them. However, insurance firms do not perceive the advantages in the same light. The main benefit, according to them, would be if coverage encouraged more individuals to seek dental insurance, which it is unlikely to occur because people would be more likely to discover that the cost of insurance outweighs the benefits provided.

The good news is that for many people, skipping insurance can actually save money, especially on non-covered procedures like dental implants.

Why are tooth implants not covered?

According to data published by the National Association of Dental Plans, 77 percent of Americans have some sort of dental insurance. Having dental coverage gives you peace of mind, but every dental insurance plan is restricted in scope. Certain treatments are rarely covered, and dental implants are frequently one of them. Devine Dentistry’s implant dentists in Belle Meade are here to explain why dental insurance is unlikely to cover implants—and why they’re still a viable option for replacing missing teeth.

Most dental insurance plans have some sort of restrictions

Each insurance policy is unique. Your plan may be limited by restrictions such as waiting periods, maximum benefit caps, and limits on how many visits you can make to your Nashville dentist in a 12-month period, depending on the coverage you have and the provider. Almost all dental plans include a yearly maximum, which is the total amount of charges that your plan will cover in a particular year.

Dental insurance, as previously stated, does not cover everything. When seeking treatment primarily for cosmetic reasons with no restorative effect, cosmetic dental work is usually not covered by dental insurance. And, while dental science advances, making care more easy and comfortable than ever before, many of the most recent developments are not covered by insurance because they are considered “experimental.”

So why won’t insurance cover dental implants?

Implants aren’t new; the first one was placed more than 50 years ago, and they’ve since proven to be a reliable way to replace lost teeth. Implants are also not considered a cosmetic treatment, despite the fact that no other tooth replacement looks or feels as natural as natural teeth.

The expense of dental implants is the main reason why insurance companies refuse to pay them. Remember that, like any other business, the fundamental purpose of an insurance company is to make money. Any insurance policy is structured to make a profit while delivering a level of care that the business thinks adequate. Many dental insurance companies will not cover the placement of a dental implant due to the high cost of the implant. In most cases, insurance providers believe a dental bridge or partial denture will serve to restore a missing tooth.

Don’t let cost dictate your level of care

Implants may be costly, but they are still the best tooth replacement option. If you take good care of your implant, it can last the rest of your life; any other restorative treatment choice will need to be fixed or replaced at some point. Implants also help you chew more effectively. They are fastened in the mouth, so unlike dentures, they will not slip or shift. The implant screw stimulates the jawbone in the same way that the root of a missing tooth did previously, avoiding bone degeneration and promoting your long-term oral health. Please speak with a representative from our office if you have any questions about pricing or whether your dental insurance plan covers any component of a dental implant.

Implant Dentistry in Nashville

You should be a suitable candidate for a dental implant if you are an adult who is lacking teeth and does not have gum disease. Make an appointment with one of Devine Dentistry’s implant dentists to take the next step. Simply dial (615) 269-4209 to reach our office.

Belle Meade, Green Hills, and Nashville, TN patients are served by Devine Dentistry.

Will dental implants ever be covered by insurance?

The majority of basic dental insurance coverage do not cover the cost of a dental implant. You should look into aesthetic dental operation coverage, which would cover a percentage of the cost of dental implants. Your dental implant insurance coverage could be 50% of the procedure’s cost, which means your insurance will cover half of the cost. Remember that depending on your other dental requirements that year, your deductible, or the amount you pay for a service before the insurance covers it, may apply.

Dental implant procedures may be covered by your medical insurance, however this depends on your policy. If you don’t have dental insurance or your current policy doesn’t cover dental implants, you can either look for a policy that does or look into affordable dental plan subscriptions.

How do you prove dental implants are medically necessary?

Our periodontal specialists can decide whether or not dental implants will enhance your oral health during a consultation.

Is there an alternative to dental implants?

Many patients are familiar with dentures, which are one of the dental implant options. Dentures are most commonly associated with full mouth dentures, which are two dentures that are designed to replace both the upper and lower arches of teeth.

When you’re missing all of your teeth or intend to have all of your remaining teeth removed due to damage or disease, full mouth dentures are a great option. You’ll look to have a full set of straight teeth with your dentures in place. Dentures are an excellent tooth replacement alternative that allows you to eat more fully than you could with only your gums or severely damaged teeth, but they don’t chew as well as dental implants or real teeth, so your diet may be limited.

Does Delta Dental cover implants?

Delta Dental, which was started in 1954, has evolved to be a well-known dental insurance provider with more than 80 million members. Individuals, families, retirees, and small companies can all benefit from these plans. To meet your needs, you can choose from PPO, HMO, and Direct Dental Plans with varied coverage options and deductibles.

The cost and coverage of Delta Dental plans vary depending on where you reside, but you can get a free quote by going to the Delta Dental website and entering your zip code. Individuals can choose from four different types of implant coverage plans:

  • Preventive dentistry is the goal of Dental Health Maintenance Organization (DHMO) plans, hence they have low or no copayments for preventive services.
  • Dental Premier plans have a per-service price, which means you won’t have to pay more than your copay and deductible for approved services in any given year.

Delta Dental covers all routine and preventive diagnostic procedures, as well as 80% of basic procedures such as fillings, root canals, and extractions, and 50% of complex procedures such dental bridges and implants. Waiting periods, annual maximums, and deductibles all apply, and these can significantly restrict the amount of coverage available for implants.

Because not all policies cover pre-existing conditions like missing teeth, you shouldn’t expect to be able to buy dental implant insurance if your teeth are already missing.

The cost of Delta Dental dental insurance is determined by where you reside, your age, the number of individuals you need to cover, and the plan you choose. Basic PPO plans, on the other hand, can cost as little as $20 per month, while premium PPO policies can cost as much as $65 per month for a 40-year-old.

How long do teeth implants last?

The implant screw can last a lifetime with proper cleaning and flossing, as long as the patient has regular dental check-ups every six months. The crown, on the other hand, normally only lasts 10 to 15 years before needing to be replaced due to wear and tear. Maintaining good oral hygiene and utilizing the crown carefully, on the other hand, may extend the crown’s life beyond 15 years. The site of a dental implant in the mouth is also a factor in determining how long it will last. Because implants in the back of the mouth are utilized more actively in chewing, they are likely to wear out faster than implants in the front.

What is the average cost of dental implants?

Dental implants cost between $3,000 and $5,000 on average. It includes the placement of the post, abutment, and crown. Separate fees are charged for bone grafting, tooth extraction, CT scan, and X-ray. In addition, the price is determined by the following factors:

  • Working with top-notch professionals reduces risks, thus the more experience your dentist has, the more money they’re going to charge.
  • Implants are most commonly constructed of titanium or zirconium. The price of these materials is determined by their quality.
  • Preliminary treatments – Additional preparation procedures such as tooth extraction, sinus elevation, and bone grafting will increase the total dental implant cost.
  • The cost of the crown is determined by the laboratory with whom your dentist works.
  • The total cost of a dental implant may be affected by the location of your dentist.
  • Individual qualities — Each instance of dental implants is very tailored. As a result, the price may differ from one patient to the next.

Are tooth implants worth it?

If you need to replace a missing tooth, dental implants are well worth the effort and money. Implants can be fashioned to look like your natural teeth and provide a sturdy foundation for permanent or removable teeth.

Decay, cavities, periodontal disease, and injuries are all causes of tooth loss. Dental implants, unlike other tooth replacement alternatives, replace both the tooth and the root. This can help prevent your other teeth from shifting due to a gap.

How are implants billed?

Implants are frequently billed under a patient’s medical plans in a dental clinic. Implants are considered dental, however most insurers will cover them if the prosthesis is used after maxillofacial surgery or to treat a traumatic injury.

Are implants covered by Medicaid?

In most circumstances, dental implants are not covered by Medicaid. Medicaid is a federal program that provides additional financial assistance to low-income families that would otherwise be unable to afford dental and medical care. Dental implants are typically seen of as aesthetic procedures that aren’t necessary for the health and well-being of those who are covered. Medicaid frequently refuses to cover these elective operations. However, there are certain exceptions.

Dental implants may be approved for patients who can show that they have a significant and established medical need for them. This will usually necessitate extensive paperwork from your doctor or dentist, as well as a letter explaining why dental implants are the only viable option for addressing your dental issue. Your Medicaid provider will also want dental X-rays and a thorough treatment plan from your doctor or dentist. In most circumstances, however, Medicaid will deny your application for dental implants.

Medicaid users under the age of 21 may be eligible for a portion of the cost of dental implants to be covered by this federal program. Medicaid-eligible children, teenagers, and young adults are eligible for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). If dental implants are required, Medicaid will usually cover the costs of the treatments and procedures via the EPSDT program. EPSDT coverage is not available to patients above the age of 21.