Is Sedation Dentistry Covered by Dental Insurance

Is Sedation Dentistry Covered by Dental Insurance?

Dentists frequently consider how to deliver the most significant advantages possible during pediatric dental care while concurrently decreasing the chance of a bad dental experience that could terrify a kid. (Antunes DE, Viana KA, Costa PS, Costa LR, 2016) In pediatric dental patients, moderate sedation aids in uplifting future behavior (Antunes DE, Viana KA, Costa PS, Costa LR, 2016). Due to the extreme intensity of the pain, dental anxiety and phobias are not only frequent in children but also highly widespread in adults. (Arpita Kapur and Vinay Kapur , 2018)

Sedation dentistry aims to reduce patient anxiety during dental procedures significantly. According to estimates, more than 50% of Americans experience mild to severe stress due to dental procedures. Obtaining dental care is hampered by dental anxiety, which is also a recognized contributor to poor oral health. (Alisha Dogra, Aditi Bhardwaj, Akshita Abrol, Abhishek Sharma, Aayushi Sharma, Anjali, Sumeet Bhatt, & Isha Sharma, 2022) Dental anxiety is influenced to greater or lesser degrees by various factors, including age, gender, education level, career, financial stability, and prior negative dental experiences. (D. Appukuttan, S. Subramanian, A. Tadepalli, L. K. Damodaran, 2015)

Sedation therapy could be a treatment you need to investigate if you have a dental phobia, feel nauseous when you encounter a syringe, or can’t stand spending a lot of time in your dentist’s office getting your teeth back to normal. ( Stephanie Watson, 2022) Patients can receive several levels of sedation from dentists, including minimum, moderate, and severe sedation and general anesthesia. ( Stephanie Watson, 2022)

Is sedation dentistry expensive?

Today, obtaining universal health coverage is seen to be possible with the help of health insurance. (Ramin Hayati, Mohammad Javad Kabir, Zahra Kavosi, Peivand Bastani, Ghasem Sobhani & Hamideh Javadinasab, 2019) Based on the kind of anesthetic you require for your treatment, the price of sedation would fluctuate. However, sedatives are generally reasonable and cheap to pay. If you want to know that “is sedation dentistry covered by dental insurance,” read the article thoroughly.

Does insurance cover sedation dentistry?

A preauthorization initiated over the phone is frequently required for accurate medical billing for oral appliances, coupled with paperwork proving medical necessity. Besides using ICD and CPT diagnostic codes, a skilled insurance coordinator starts a benefit verification call. The patient is then informed about copayments and deductibles. Remember that oral appliances for OSA are not limited in any way throughout a lifetime. Some medical insurance companies may offer a new gadget after three or even five years. Providing proof of medical need is essential after the procedure has begun.

How to know if you’re a candidate for sedation dentistry?

Sedation dentistry is what you require if you can affirmatively relate to even one of the following questions;

    • Have you ever had a negative dental encounter that makes you reluctant to seek treatment?
    • Are you experiencing a particularly sensitive tooth or a powerful gag reflex?
    • When thinking about an upcoming dentist appointment, do you experience fear and anxiety?
    • Do you find it hard to numb yourself comfortably using conventional methods?
    • Do you need to complete multiple complicated dental operations as quickly as possible? Avoiding care and skipping routine dental visits were both linked to anxiety. (Emmanuel Nicolas, Valérie Collado, Denise Faulks, Brigitte Bullier & Martine Hennequin , 2007)
    • Is it extremely challenging for you to remain still for extended durations?

You must receive sedation if you meet any of the criteria asked above.

When does insurance cover sedation dentistry?

Your insurance plan might pay for general anesthesia because it might be medically necessary for the patient to be asleep during the procedure. According to the treating dentist and patient viewpoints, sedatives for complicated dental procedures have grown in popularity recently because patients have become more aware of the various options for anxiety reduction therapy. (Beenish Abbas, Ayesha Maqsood, Syeda Rabia Rahat Geelani, Madeeha Sattar, Majida Rahim, Zohaib Khurshid, 2022).

    1. Discuss with the practitioner or the person who handles insurance companies at the dental practice. However, be critical to verify coverage with your insurance plan’s carrier.
    2. Request your dental professionals to ask your insurer to pre-authorize your sedation if any of the following conditions apply to you.

However, your dental insurance must cover the cost of using sedation with the exemptions. Among them are:

    • When prolonged therapy: These sedatives may be covered if treatment is postponed or prolonged due to fear.
    • Sedation will lower the total cost of care: If gaining the procedure results in decreased average health care expenditures, coverage will be partially covered.
    • You must undergo a complex treatment: If someone is having a complicated procedure (Beenish Abbas, Ayesha Maqsood, Syeda Rabia Rahat Geelani, Madeeha Sattar, Majida Rahim, Zohaib Khurshid, 2022), there are possibilities that insurers will pay for the treatment.
    • When you have been diagnosed with a severe medical condition: When the patient needs sedation dentistry to complete a dental emergency due to a medical issue
    • Milder sedation: A milder kind of sedation, such as nitrous oxide or oral conscious sedation, which both have lower provision costs, might make it even more convenient to obtain insurance coverage. Midazolam is a medication regularly used for mild sedation during dental surgery. Nitrous oxide is also an effective drug for sedation. (Jose-Ramón Corcuera-Flores, Javier Silvestre-Rangil, […], and Julián López-Jiménez, 2016)

What to do if your insurance company refuses to cover sedation dentistry?

If you desire to proceed with the procedure despite your insurance company has denied covering the sedation, then specific options are available. With these approaches, you will still get the necessary treatment without experiencing any stress.

To assist you in sticking within your budget, the dental practitioner and dental staff will collaborate with you to determine alternate payment choices or adopt financing options to divide the expense of your procedure.
Connecting with a third-party funding provider is an additional option. Look for specialized coverage that will pay a higher premium and include sedation dentistry.

Hire MedsDental Billing Company- a trustable billing service provider

MedsDental Dental Billing Company, as 3rd party billing services provider, can aid your practice regarding billing. The competent personnel at MedsDental billing organization will provide your clinic with the particular attention it requires. As responsible for handling your billing area, we check the insurance eligibility and coverage of the patient so that you can know about the coverage of certain services you will render. We have expertise in forming error-free claims by implementing the correct codes and dealing with claim denials on time. Our HIPAA-compliant services comprise a streamlined revenue cycle solution; hence our technology-empowered RCM workflow process helps your facility gain extra profit. While we take care of your revenue cycle, you can take great care of your patients.

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