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Will Dental Insurance Cover Your Emergency Appointment?

February 26, 2021

Filed under: general dentistry — drwest @ 1:58 pm
Notepad reading “Dental Insurance” surrounded by medical equipment

Dental insurance plans are different from medical insurance plans in that they mainly focus on prevention; that’s why your regular checkups and cleanings are often fully covered. But what if the worst has already happened? What if you need to have an infected tooth pulled or are suffering from oral pain that continues to grow worse and worse? Can you still count on your dental insurance to help reduce your out-of-pocket costs? Whether you’re visiting a practice for the first time or already have a dentist you can turn to for urgent care, it’s important to be aware of what is – and is not – covered by your dental plan in the event of an emergency.

Is Emergency Care Covered Under Your Plan?

While every dental plan offers different benefits, most of them will offer some level of coverage for emergencies. However, the exact amount that your insurance carrier is able to cover will vary depending on what kind of treatment is required. You can often expect your plan to cover up to 80% of the cost for minor restorations such as fillings, but for more extensive treatments like tooth extraction and crown placement, the coverage is usually around 50%. Before beginning any sort of emergency treatment, it’s important to confirm what type of coverage you can expect.

What Will My Out-of-Pocket Costs Be with Dental Insurance?

The answer to this question will not be the same for everyone. After all, no two dental emergencies are the same, and different treatments come with different costs attached. And of course, there’s your own unique situation to consider. Factors that affect out-of-pocket cost include:

  • The type of treatment required and the level of coverage your plan offers for it.
  • Whether or not you have met your deductible for the year.
  • Co-pays, or set dollar amounts that you by yourself.
  • The annual maximum, which is the total amount of money that your insurance company sets aside for your care each year.

What Will a Dental Plan Not Cover?

Dental insurance typically does not help pay for emergency room or urgent care visits. You might have to call an emergency room if your dental issue is having life-threatening consequences, such as making it difficult to breathe or causing unstoppable bleeding. Such cases are typically covered by medical insurance instead. Also, since each dental plan is different, there’s a chance of your policy not covering specific kinds of care. It’s a good idea to call your insurance company directly if you’re not entirely sure what kind of coverage you’ll receive in the event of an emergency.

Dental emergencies are always frightening, but if you’re aware of the kind of insurance coverage you have, you’ll be in a better position to get the care you need without having to worry about the cost. Take the opportunity to learn about the specifics of your insurance now so that you’re in a better position to act when you need it most.

About the Author

Dr. Pamela J. West was recently recognized as one of the “Top Dentists” in Summerlin and has also been voted the “Top Female Dentist” by her peers. Her practice, the Summerlin Center for Aesthetic Dentistry, offers high quality emergency care in a relaxing, spa-like environment. Dental insurance is always welcome, and Dr. West’s team will always handle the claims for you. To learn more about our emergency services and how dental insurance works at our practice, visit our website or call (702) 844-6224.

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