Planning Dental Implants To Maximize Benefits Usage

Dental implants, whether for an individual tooth or several missing or damaged teeth, offer patients the opportunity to improve their appearance, ability to talk and eat comfortably, and overall oral health. Unfortunately, the cost of dental implants sometimes causes patients to delay or forego dental implant placement. At Herald Square Dental, we understand that cost is a consideration and work with our patients to ensure their dental benefits are maximized.

Dental Coverage Limits

If you have dental insurance, you are probably aware that there are limits for coverage in any given year. Once your insurance provider has paid out the maximum for the year, they will not pay for any additional work. These caps are standard for most dental insurance coverage and one of the main reasons individuals hesitate to get dental implants. Fortunately, the nature of dental implant procedures makes it easier to “divide and conquer” the cost issue.

In The Good Old Summertime

We recommend getting dental implant surgery during the summer or the last half of the year. Dental implants require several weeks or months to fully integrate with the jawbone before the final restorations are placed. Suppose you have your dental implants placed in the summer or early autumn. In that case, you can schedule the attachment of the permanent restorations for the following year. In the meantime, your dental insurance coverage resets.

If you wait until either the new year or the beginning of your new insurance cycle for the permanent crowns, your insurer pays the maximum amount possible for the crowns because you have not yet used any coverage for that year. The implant procedure itself may be partially paid for during the year the surgery is performed but could max out your coverage. Remember that a temporary cap or crown will cover the implant during osseointegration of the implant and jawbone, so you will not be without a complete set of teeth during this waiting period.

Do Your Homework

Although not every dental insurance plan covers dental implants, you may be surprised by how much your policy covers. Placing a dental implant may require several separate procedures, including bone grafting and creating the permanent crown. Some of these steps may be covered while others are not, so be sure to ask about each phase of your tooth replacement.

Tooth Extraction

If you have a single damaged tooth or a few that need pulling. If the tooth has to be removed because it cannot be repaired, the extraction may be fully or partially covered by your insurance.

Bone Grafts

When the jawbone is not strong enough to support an implant, we may recommend bone grafting or APRF to build up and strengthen the area.

Implant Surgery

Placing a dental implant is considered a major dental procedure. While coverage varies, most dental insurance plans cover 50% of dental implant surgeries up to a cap for the year.

The Restoration

The crown or artificial tooth may be covered all or in part, particularly if you had to have the natural tooth removed because of damage or decay. The reasoning is that the crown is a preventative measure, reducing the chance of complications and tooth decay in the future. Some insurance providers will cover all or most of the restoration (up to the policy’s cap for the year).

Negotiate With Your Insurer

Many dental insurance providers provide partial coverage for dental implants. Others classify them as a cosmetic procedure and do not cover them but cover the cost of dentures. If they pay for dentures, you may be able to negotiate an alternative where they agree to offer the price of dentures toward your implants, with you making up the difference.

Do Not Forget Medical Insurance

There are some situations when your medical insurance could cover dental implants. Coverage may be available if your tooth was damaged in an accident or lost due to a congenital defect. Teeth lost to cancer and any tooth loss that leads to medical complications may also allow for dental implants under medical insurance. If you have both medical and dental insurance, you may be able to turn in different dental implant procedures under each policy for maximum coverage.

How Herald Square Dental Can Help

Figuring out the cost of dental implants and how to pay for them can be intimidating, but our team can help. If you have questions regarding insurance coverage, our highly trained staff can help walk you through your options.

An initial consultation to discover whether a dental implant is the right way to replace your missing tooth or teeth is the first step. At Herald Square Dental your dental implant consultation is free. Why do we do this? So that our patients can make informed decisions. This summer your initial consultation includes a complimentary CAT scan that provides images used during implant procedures, further reducing your out-of-pocket costs.

To learn more about maximizing your insurance coverage for dental implants or to schedule your free dental implant consultation, contact our office today.
Call us: (212) 689-0024