Dental implant tooth replacement has the potential to significantly improve your appearance, so you might think of it as a mere cosmetic treatment. The truth is, though, that dental implants have some major health benefits! In some cases, health insurance even deems them a medical necessity. This blog post delves into what that means and how you might be able to receive coverage.
What Does It Mean for a Treatment to Be Medically Necessary?
Every insurance company has its own definition of what it means for something to be medically necessary. Some common criteria may stipulate that the service is:
- Clinically appropriate.
- Not primarily for a patient’s convenience.
- Not more expensive than procedures that deliver the same level of effectiveness.
- Not for experimental or purely cosmetic purposes.
Determining Medical Necessity for Dental Implants
In many cases, dental implants can be defined as medically necessary because:
- They improve chewing power, which can lead to improved nutrition and a reduced risk of some systemic diseases.
- They can prevent further tooth loss.
- They are superior to other forms of tooth replacement.
- They can improve overall quality of life.
Often, an insurance company will ask a lot of questions in order to determine if dental implants meet their definition of a medical necessity. They may approve payment if a patient’s tooth loss was the result of an accident, advanced gum disease, or other serious health problems, such as cancer or chronic GERD.
The Process of Using Health Insurance for Dental Implants
If you are interested in using your health insurance for dental implants, you should:
- Visit a dental implant care provider who accepts your insurance. They will examine your mouth and form a professional opinion on whether you are a good candidate for dental implants.
- Seek preauthorization. Your insurance might require preauthorization before your procedure.
- Understand your out-of-pocket obligation. Even with insurance, you may end up paying a significant amount of money out-of-pocket. You should understand your end of the deal before you commit to anything.
What if Your Insurance Will Not Cover Implants?
If neither your dental nor medical insurance will cover your implants, despite your dentist’s opinion that they would be extremely beneficial for you, you may be able to take advantage of other provisions. For example, you might qualify for a low-interest payment plan.
Dental implants can be a medical necessity! Attend a tooth replacement consultation to learn more about how your insurance might apply.
Meet the Practice
At Radiance Dentistry Dental Implant Center, we are proud to be in-network with BlueCross BlueShield health insurance, and we can file PPO claims with all major insurance providers. We are experts at establishing medical necessity, and we are eager to advocate for our patients. To learn more about how we may be able to serve you, contact our Irving office at 972-866-7976.