You may already know that brushing and flossing twice daily is a simple but effective way to prevent common problems, like cavities and gum disease, that contribute to many dental emergencies. However, there’s no guarantee that you won’t develop an issue requiring immediate attention at some point.
Many people want to know whether their dental insurance will help cover the cost of their urgent appointment to reduce their out-of-pocket expenses. If you have a policy and are uncertain what’s included, continue reading to learn more about it!
How Does Dental Insurance Work?
Although there may be exceptions, most dental insurance programs are designed to promote proper preventive care to reduce the likelihood of more complicated issues that require more expensive and complex services to fix.
As a result, they often break up their coverage into a 100-80-50 structure as follows:
- Preventive care. Many plans include 100% of routine checkups, cleanings, and annual X-rays to monitor your oral health and avoid potential problems.
- Basic procedures. Often, up to 80% of common treatments, like tooth-colored fillings, root canals, or simple extractions, are covered.
- Major procedures. Many insurance providers reimburse up to 50% of major treatments, such as dental crowns, bridges, or dentures.
What Is Considered a Dental Emergency?
If you’re having an unexpected problem, like you’ve chipped a tooth or lost a crown or filling, it’s natural to wonder how serious it is and whether you need help immediately. There are many reasons you might need to call your dentist to schedule a same-day emergency appointment, such as:
- Severely decayed, injured, or aching teeth requiring extraction.
- Repairing damaged teeth with dental bonding or dental crowns to restore their appearance and functionality.
- Treating infections or draining tooth abscesses.
- Replacing lost or broken teeth or restorations.
It’s best to contact your dentist to let them know what happened, even if you’re unsure whether your condition is usually considered urgent. They can schedule an appropriate time to see you and provide any additional care instructions over the phone as needed.
Does Dental Insurance Cover Emergencies?
Whether or not your dental insurance policy will reimburse your emergency services depends significantly on your unique circumstances. For example, if you have an infected tooth requiring extraction and replacement, the initial examination and imaging may be fully covered, while the procedure and restoration are only partially included in your plan.
You can contact your insurance provider directly if you’re unsure whether your plan will pay for the treatments needed to save your smile. You might also request your dentist’s help finding the necessary information and filing claims on your behalf.
Meet the Author
Dr. Kathy Lam enjoys establishing meaningful relationships with patients to help them build and maintain a beautiful, healthy smile. She earned her Doctor of Dental Surgery at the Howard University College of Dentistry and continues to hone her knowledge, skills, and abilities through continuing education courses through Spear. Today, she has more than 20 years of experience offering a comprehensive menu of services to meet all your needs under one roof, including emergency dentistry. If something has happened and you need help, you can request an appointment on the website or by calling (630) 653-7720.