Is Sedation Dentistry Covered by Dental Insurance?

Sedation dentistry covered by dental insurance or not, has been one of the worrying factors among dentists as the procedure is expensive and distinctive from other necessary dental treatments that require urgent recovery. That is why dental insurance providers do not deem sedation dentistry a standard or essential practice to offer reimbursement for; instead, they see it as a “non-essential dental procedure.” Moreover, the procedure is occupied by “luxury” treatments like “dental implants and cosmetic surgery, carrying a high cost, keeping the patients from deciding earlier to take the calming embrace of sedation during the anxiety-provoking dental treatment. However, there are several factors when the insurance can cover the procedure, such as the type of sedation, your patient’s needs, and the cost of sedation. This guide aims to enhance your knowledge and understanding of situations when your patients can best benefit from insurance for sedation dentistry without emptying their pockets. Keep exploring to encourage your patients on deciding to take the treatment a breeze.

Why Sedation Dentistry is Important for Dental Patients?

Acquiring sedation dentistry becomes essential in many cases for Specialty dental care patients as it helps them feel less stressed while experiencing the necessary dental care. It facilitates a smoother procedure and addresses anxiety and phobia of taking dental care when awake. Moreover, patients with medical or mental conditions can also get comfort while undergoing the procedure. Here are some significances:

• Sedation dentistry eliminates anxiety and fear of not taking the necessary dental care.
• It enhances patient cooperation for dentists who can perform the service more efficiently and with better outcomes.
• It is far better for sensitive patients as the procedure enhances pain management.
• Facilitate patients with lengthy and complex dental procedures requiring patient relaxation.
• Dentists can efficiently proceed with care provision with fewer interruptions of patient discomfort.
• Help individuals decide on taking dental care without being daunted or having any fear of pain or anxiety.

Sedation Dentistry And Dental Insurance Coverage

Despite the proven benefits of sedation dentistry across the US, dental insurance companies deny coverage for procedures such as sedation in dentistry, categorizing it as non-essential procedures similar to cosmetics or implants. Moreover, a standard dental plan does not cover sedation dentistry because it costs as much as the whole treatment itself. Hence, patients are usually left on their own when it comes to covering sedation dentistry with its pricey premiums.
However, there are certain areas to be noted when insurance coverage can compensate for the sedation:

• Dental insurance providers tend to cover some of all the sedation-related expenses and using sedation lowers the overall dental treatment cost.
• If the patients’ anxiety causes treatment delays or spaced out in intervals, the chances of insurance increase for sedation.
• Insurance may cover the necessary sedation if it is executed in the nitrous oxide form instead of the intravenous form.
• Coverage is offered if the patient is in a severe medical condition or disability requiring immediate dental care with sedation, such as autism, cerebral palsy, mental retardation, and epilepsy.
• Insurance companies also cover sedation when the procedure is exceptionally complex.
• When the patient is enrolled in an expensive policy proposing specific benefits for sedation dentistry.

Types Of Sedation Dentistry And Dental Insurance

Coverage in dental plans might vary as per the varying types of sedation your patient needs. Moreover, each insurance policy differs depending on the location and insurance provider. Patients seeking sedation must get involved in researching the different types and coverage options associated with sedation to determine their specific needs and the nature of the dental procedure.
To make you clear on the variations, here is the explicit chart describing each sedation type treated differently by the dental insurance provider:

Types	Explanation	Insurance Coverage
Nitrous Oxide (laughing gas)	Lighter form of sedation Coverage varies according to the dental insurance plan	Some plans include Nitrous Oxide covered by dental insurance as routine dental procedures Others see it as optional with limited coverage offered
Oral Sedation	Involve prescribed medications Can differ based on the insurance provider	Categorized in insurance plans differently Variations in coverage levels For some plans, it’s a necessary part of certain procedures Others may offer limited coverage
Intravenous (IV) Sedation	Administered through a vein Proceeded differently by different insurance providers	Some dental insurance cover IV sedation as a specialized service due to its control of sedative levels, impacting coverage Dental insurance that cover IV sedation differ in coverage
General Anesthesia	Reserved for complex procedures Closely monitored by Anesthesiologists	Dental insurance plans approach coverage differently for general Anesthesia Providers consider factors like medical necessity and the nature of dental work
Local Anesthesia	Not classified as sedation Local Anesthesia for pain control is a standard part of dental procedures	Coverage is usually included in dental insurance plans Considered often an integral part of routine dental care

Insurance Providers That Offer Coverage For Sedation Dentistry

Delta Dental

A well-known dental insurance provider that offers extensive coverage. They can provide sedation dentistry varyingly depending on the specific plan within the company network. However, policyholders must review the policy documents, exclusions, and coverage limitations on sedation. Moreover, Delta Dental sedation coverage may categorize the practice based on medical necessity, and a specific type of sedation used. The delta dental cover IV sedation also.

Cigna

The insurance plans at Cigna are approved for their diversity, including coverage for sedation dentistry. However, these providers cover sedation if it is medically necessary or when prescribed by the dentist to facilitate necessary dental practice.
Policyholders must consult their plan details and the specific criteria for sedation coverage eligibility. These are committed partners in delivering patient-centered care that influences coverage considerations for sedation.

Aetna

These are reputable insurance providers extending coverage for sedation dentistry services. However, the policyholders must carefully analyze the terms and conditions for coverage. Aetna offers coverage based on the type of sedation, the nature of the dental procedure, and the individual’s plan’s policy.

Guardian

These insurance providers also comprise a comprehensive set of coverage options, including the benefits of sedation dentistry procedures. However, the coverage depends on the policyholder’s chosen plan, the necessity of sedation for specific dental procedures, and coverage eligibility.

What To Do If the Insurance Company Refuses Coverage For Your Patients On Sedation Dentistry?

If the patient desires to proceed with the procedure despite their insurance providers having denied covering the sedation, then specific options are available. These approaches may help them get the necessary treatment without experiencing any stress.
They can collaborate with the dental practitioner and dental staff to determine alternate payment choices or adopt financing options to divide the expenses of the procedure. Furthermore, connecting with a third-party funding provider is an additional option. They must seek specialized coverage that will pay a higher premium on sedation dentistry or find practices offering many choices to make sedation dentistry affordable, such as in-house saving plans.

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