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Is Sedation Dentistry Covered by Dental Insurance?

July 19, 2020

Filed under: Uncategorized — dentist_tappan @ 4:52 pm
a patient under sedation while receiving dental care

Do you need a procedure that requires you receive some form of sedation? Unsure if insurance will cover the costs? While you probably have numerous questions about the need for a particular procedure, you will likely want to know, “Is sedation dentistry covered by insurance?” Unfortunately, there are certain stipulations that insurance companies can put into place when it comes to receiving nitrous oxide, oral medication, or an IV to make you comfortable for dental treatment. Read on to hear from a local dentist who can shed some light on the topic and offer additional solutions, so you don’t have to forgo the care you need.

Does Insurance Cover Sedation Dentistry?

Unfortunately, most dental insurance companies and standard plans do not cover the cost of sedation dentistry. As disappointing as it may be, this out-of-pocket expense should never keep you from seeking treatment. Yes, the use of nitrous oxide, oral medication, or an IV can help you to feel no pain and remain completely comfortable during your procedure, it will likely require that you look for alternative ways to pay or establish a budget well in advance of your treatment.

Why Is It Not Covered?

In certain situations, many insurance companies believe the use of sedation will be the same or more than the actual cost of treatment. As a result, insurers consider to be “non-essential” and place it into the same category as cosmetic dentistry and/or dental implants. It is also believed that many companies would require higher premiums if sedation dentistry were to be included as part of the covered benefits a patient receives when enrolling in a plan.

Are There Exceptions?

There are few exceptions when it comes to having your dental insurance company pay for the use of sedation. These include:

  1. Its use lowers the cost of the overall treatment
  2. If treatment is delayed or spaced out because of anxiety
  3. If the patient has a medical condition that requires sedation dentistry to perform a dental procedure (i.e. autism, epilepsy, cerebral palsy, etc.)
  4. If a person is undergoing a complex procedure (i.e. oral surgery, multiple tooth extractions)

How to Pay for Sedation if Insurance Refuses to Cover It

If your dental insurance company refuses to cover the cost of sedation, but you want to move forward with treatment, there are ways in which you can still receive the care you need and feel no pain during the process. Your dentist and dental team will work with you to identify alternative payment methods or pursue financing options to break up the cost of your treatment to help you stay within your budget.

Many dental offices work with CareCredit and/or offer in-house savings programs to help patients minimize out-of-pocket costs, so don’t let your insurance company keep you from getting the treatment you need.

About the Practice
At Smile More Dentistry, we want our patients to feel calm, comfortable, and safe during their visit. Knowing that dental work can be costly and even unpleasant, especially for those who have anxiety about visiting the dentist’s office or are preparing to undergo a procedure, it is our job to ensure you receive the care you need without the discomfort and worry that can come along with it. If you or a loved one need complex dental work and are unsure if insurance will cover the cost of sedation, visit our website or call (845) 675-1512.