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How Does Insurance Cover Anesthesia For Dental Procedures?

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If you or your child needs to go to the dentist and have to be put under with anesthesia, you will want to understand how that will be covered by your dental and medical insurance plans.

What Exactly Does Dental Insurance Cover?

It's important to note that dental insurance usually only covers basic treatments and procedures such as cleanings, routine examinations and fillings. Normally, with dental insurance you only need to pay your monthly premium and there is no deductible to meet first. Some dental plans will require you to pay an upfront payment called a copay. A good dental plan will cover routine exams, procedures and anything else deemed preventive at 100 percent. For root canals, crowns and other invasive procedures, your dental insurance may only cover a certain percentage.

How Does Insurance Cover Anesthesia?

If a dental procedure requires anesthesia or conscious sedation, it is usually considered a surgical procedure. Because of this, most dental plans do not cover anesthesia. Normally your dentist office will ask you to check with your medical insurance to see if they will cover it. Sometimes, your dental insurance may require the dentist to submit the anesthesia claim to the medical insurance first. If they deny it, then your dental insurance might cover it.

Not all dental and medical plans are the same. Each carrier covers certain benefits which is why it is always the best policy to check with both of them to see how anesthesia is covered.

Exceptions for Anesthesia

As with most things in life, there are exceptions to every rule. Most medical insurance plans have to cover anesthesia if the person receiving the dental work falls into one of the following categories:

  • The patient is younger than six years of age
  • The patient has a disability or other medical condition where it would not be safe to do dental work without anesthesia
  • The patient exhibits being uncooperative during a dental procedure or has extreme fear or anxiety about the procedure
  • The patient does not respond effectively to local anesthesia
  • Patients who are getting wisdom teeth removed
  • The patient has severe facial trauma

While most insurance plans in most states cover anesthesia in these instances, they may only do so if it has been authorized by the insurance company before the procedure is done. Again, it is best to talk to your medical insurance carrier to find out their policy and what exactly they cover when it comes to anesthesia for dental procedures. (For more information on dentists, contact Claremont Dental Institute)