Insurance Coverage for Part of Implants?

Shauna, an office manager, asks:
Are there any insurance companies that pay part of the cost of implants? I get this question over and over again from patients. The next question, patients often ask, is why insurance companies don’t pay for implants when they will pay for crowns? I just don’t have any good answers for them. How do you approach this question? Finally, are insurance policies for mini implants different than conventional implants?

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10 thoughts on “Insurance Coverage for Part of Implants?

  1. Our Blue Cross (in Massachusetts) pays 50%. This is from their beneift summary:

    Single-tooth dental endosteal implants (the
    fixture and abutment portion) in addition to
    the allowance for the crown for the implant,
    once each 60 month period, when the
    implant replaces permanent teeth through the
    second molars (members age 16 and older)

  2. just tell them that most dont cover implants, because if they payed 1 implant per customer a year they fear they would go broke and insurance is still a bussines

  3. It is a pity that implants are not covered, after so much research and proof that implant prosthesis will outlast ordinary crowns and bridges.

    In Canada, insurance companies will pay for bone grafting proceedures and the extraction of teeth, residual roots etc.

    In our office, when a person is missing a tooth, and the treatment of choice would be a single tooth implant and crown, rather than destroying two perfectly healthy adjacent teeth.

    We send in a predetermination to the insurance company, asking what their responsibility would be to the patient and how much they would be willing to pay for a conventional fixed bridge.

    When it has been established and confirmed in writing what amount the insurance company would be willing to pay for a conventional prosthesis; we then send a letter to the insurance company establishing the fact that the standard of care today to replace a single tooth is an implant and crown, and include with our letter, a letter from the patient insisting that they do not want two adjacent teeth to be mutilated in the process, and that it is a violation of their personal rights to dictate to them how their teeth should be repaired, when the insurers are in fact not even dentists.

    In cases where the patient is a member of a large group policy, the insurer does not want to risk the possibility of losing a large account because of unhappy and disgruntled policy holders who will talk amongst themselves, and does pay the same dollars for the implant treatment.

    If more dental implant practitioners would take this stance, implant dentistry would be covered to the same annual amount as is paid for standard crown and bridge.

    Gerald Rudick dds Montreal

  4. Some insurance companies (like Met Life) in our region (So. Cal) are covering implants, the abutments and the abutment supported crowns as they would any major procedure. I wish they wouldn’t. The problem with coverage comes their negotiated fees…which are always lower than UCR. Patients are always accepting of the procedure and willing to pay for it if presented correctly! Give me the “good ol’ days” when it wasn’t covered or on any fee schedule and they were deemed “experimental” by the insurance companies even though they had research based proof of thier greater succes rate!

  5. I am thrilled that some Ins co’s have paid. I do have the State of IL pay ($2,000 for placement and almost another $2,000 for the abutment head and crown – thought htey max @ $2,000 per year we do it over two fiscal years) and BCBS – I let the companies know who is paying and to get with the current care. Any amount paid to it helps our patients. I have ask that the others pay at least the same amount the pay towards a regular crown. I have not tried the letter for the patient – but I will – maybe if the patient and I are lucky it will work. Good luck to us all in making the change

  6. Ber careful of insurance coverage with dental implants. Look at everything else, insurance has become involved with. The eventual outcome is PPO’S DMO’S ETC. You will be working for less! Don’t be a weak sister!

  7. I am an implant coordinator in a surgical office, and I have found that there are several Delta Dental plans that have added surgical implant placement into their standard coverage; however, it is up to the employer to add it into the contract. So encourage your patients to talk to their HR rep at their company. I have also seen Metlife, Aetna and Cigna, as well as Guardian pay for a portion of implants (surgical and prosthetic). AFLAC even has a benefit! There are some cafeteria plans that have it as well. It is becoming more and more prevelant, but not as widespread as it should be!

  8. I have found that Aetna under medical is paying $862 per implant including the implant. A fee which is 2/3 of the dental fee. Has anyone been able to bill seperately for the implant or managed to quite some Aetna plans and not others?

  9. I have been tring to find insurance that would cover some of the cost for implants and was having a hard time. Since I saw this site am going to contact some of these companies to try and get coverage.I am self employed so I need to get a good rate.

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