Is dental implant treatment covered by dental insurance plans?
It’s important to note that Insurance Companies are publicly traded entities. Their main interest is on creating profits for their various shareholders, not paying out benefits to their various plan holders. In fact the two are in direct conflict with one another. Insurance companies make profits by not paying out benefits to policyholders.
Insurance coverage of implant treatment depends on the individual policy. However, it is rare to receive any substantial coverage. Since the benefit coverage is determined strictly by the amount the employer wants to spend on the policy, and the insurance companies want to build in their profit margins, there are major limitations on most dental insurance plans. In reality, the plans are only designed to cover routine maintenance, emergencies and basic care.
The insurance companies use statistical data to determine the most common procedures submitted on claims, and then they set their own "usual and customary fee" schedule for these procedures. They also determine the specific restrictions and limitations for each plan. Because the plans are only intended to cover the basics, there is an annual maximum allowable benefit of $1,000-$1,500 on most plans.
Although most companies exclude implants as a covered benefit, many of the will pay the same benefit they would cover for the lowest cost alternative treatment option (partials and dentures) and some of the diagnostic records, if a specific request is made for "alternative benefits". Even if an individual policy includes implants as a covered benefit, the amount of coverage is still limited to the annual maximum allowable.
Your local dental provider will be happy to look into your dental plan to see if you qualify for dental implant coverage. They will look to see if your plan contains an “Alternate Benefit Clause” or a “Health Spending Account”.