If you’re thinking about replacing a missing tooth, or fixing an ill-fitting denture, getting surgery for dental implants requires definite consideration of the cost for the dental implant. Most people who have insurance through their jobs will have a plan through a major dental insurance carrier like Delta Dental, Metlife, or Cigna, to name a few. There are a lot of restrictions and common misconceptions about dental insurance when it comes to dental implants.
The costs for dental implants vary due to a large amount of determining factors. Our office provides consultations for anyone interested in the costs to replace missing teeth.
Top Misleading Dental Insurance Clauses:
- Waiting periods: This simply means that you must pay for the plan first before you can use it. Essentially, it is a LAYAWAY plan. The waiting period varies from patient and can be as long a 3 months to five years! When patients are confronted with this information they may decide to wait until the “waiting period” is over, but why would you want to pay for something for five years before you can use it? The monthly premiums that you pay add up and you could pay for the cost of the dental implant outright.
- Fee Schedules: Each insurance company either pays the dental provider based off of a certain percentage (they will pay 100% of your visit, regardless of the dental office’s fee) or by dollar amount (They will pay $58 toward your visit, regardless of the dentist office’s fee). The latter is called a “fee schedule.” For a plan that pays based off of a “fee schedule” the patient is usually getting the short end of the stick. In the plan booklet it will say “We pay 100% of the fees” … i.e. their fees. They will only cover a portion of the cost that the insurance plan dentermines, not the fee that the dental office charges. The patient ends up paying the difference! The amount the the dental insurance company pays to the office on your behalf, or their “reimbursement” is sometimes laughable.
- Alternate Benefit, or “the cheapest option”: Some insurance companies may help replace the missing tooth but they will only do so if they pay based off of the cheapest way to replace that tooth. For example: You need a dental implant and you have implant coverage. But the insurance says they won’t pay for the implant because the patient can just get a partial denture to replace the missing tooth. So even though the patient doesn’t want a partial denture because it is uncomfortable and unsightly, the insurance carrier doesn’t care! Again, the patient is the one that ends up paying the difference.
- Individual Plans: It’s not uncommon for people to get plans purchased on their own from a company, not through an employer. We find that these plans have very to little coverage (usually on $500/yr) and have ALL of the above stipulations. It is likely that they do not cover implants, or any service besides a dental hygiene visit.
HMO vs. PPO
HMO insurance is appealing because it is more affordable. However, you must go to a specific dentist that is determined by your medical plan.The offices are usually in a clinic-like setting where they hurry up to get you in and out and Wham Bam Thank ‘ya Ma’am type of service.
PPO plans give patients more choices for who they choose to do their dental care and up until recent years patients with PPO plans were able to see any dentist they chose. That is why they are more expensive for the patient. However, in the last few years dental insurance plans have started changing things and now some PPO insurances have their own networks they the patient must utilize. Not to fret, most plans still offer out-of-network benefits and pay similarly for co-pays as if the patient saw an in-network provider.
While it can all be a bit overwhelming for patients, our staff is very well versed in dental billing for dental implants. We have an outstanding team that helps people better understand their coverage. Although insurance coverage is only an estimate, we will help you to maximize your dental benefits.
No dental insurance, No problem!
Our office’s philosophy is that we do not let dental insurance companies dictate what is important for our patients and what our patients’ needs are. That is why we allow our patients to choose from our low monthly payment options using a company like CareCredit. We also have many patients who sign up for our Dental Savings Plan which gives an additional 20% discount with membership off of the implant services.