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Will Dental Insurance Cover Emergency Visits?

December 9, 2021

Filed under: Uncategorized — ridgepointdent @ 2:20 am
Woman with toothache

Many Americans out there have dental benefits through either their employer or by another means. However, many people don’t fully understand how their dental insurance comes into play. You know that you can head to your dentist for routine cleanings and checkups, but what if you have to go to the dental office unexpectedly thanks to an emergency? Continue reading to learn how your dental insurance will play a role.

What Different Types of Dental Insurance Plans Are There?

Here are the three most common options when it comes to dental insurance:

  • Preferred Provider Organization (PPO): This plan allows you the option between a list of dentists that accept the plan or choosing your own dental provider. If you go to a dentist that is out of network, your out-of-pocket costs will typically cost more.
  • Dental Health Maintenance Organization (DHMO): These plans provide a network of dentists that accept the plan for a set co-pay, or no fee at all. However, you much choose one of these dentists and will not receive coverage on ones that are not in-network.
  • Discount Dental Plan: Here you get a discount on dental services from a select group of dentists, but the plan doesn’t cover your care. Instead, the participating dentist will give you a discount on your treatment.

What Do Your Dental Benefits Cover?

Every dental plan is different, so you will need to seek this information from your insurance company to be certain. Here is a typical structure you’re likely to see:

  • 100% of preventive care: This includes checkups, cleanings, and routine x-rays.
  • 80% of basic procedures: Basic services include fillings and periodontal scaling.
  • 50% of major procedures: This includes more complex services like dentures and orthodontic treatment.

Every plan has a cap on how much it will cover each year. This is known as your annual maximum. After you reach this amount, you are fully responsible for additional expenses.

Will Emergency Dental Treatment Be Covered?

This completely depends on the type of emergency that you have and what treatment you require in order to restore your oral health. For instance, if your emergency is due to a cavity and you end up needing a filling, 80% of the treatment will likely be covered by your plan. If you need a more complex procedure, you may be left responsible for half of the cost. Just keep in mind that the longer you put off a dental issue, the worse it will get. If you have the issue dealt with now, you are much less likely to save money in the long run.

If you’re worried about the cost of your emergency treatment, talk to the dental team. They may be able to help with other financial options. Receiving essential care shouldn’t mean stressing over finances.

About the Author

Dr. Sweeta Walia is an experienced dentist who has been working in the field for over 15 years. She earned her dental doctorate from the Nova Southeastern University School of Dental Medicine before completing a General Practice Residency at Staten Island University Hospital. To further advance her clinical skillset she’s also become a Master of Implant Prosthesis through Hiossen International Implant Training. Her practice is in-network with most major PPO plans. For more information on emergency dentistry or to schedule an appointment at her office in Keller, visit her website or call (817) 952-8100.

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