What Makes Dental Implants Medically Necessary?
Patients who are in need of dental implants may be apprehensive about potential insurance coverage limitations. Often perceived as a cosmetic procedure, these individuals usually assume that their treatment will be totally out of pocket. In reality, these treatments are often categorized as medically necessary, rendering them eligible for coverage from their insurance company.
At Hardin Dental, our team of experts possesses all of the necessary skills to address your concerns. We have performed countless dental implant procedures, allowing patients to enjoy a higher quality of life.
How Do Dental Implants Work?
While many patients are familiar with the term “dental implants,” some don’t have a clear understanding of what they entail. They essentially serve as a means of replacing missing or compromised teeth. The dental implant process usually involves three phases.
- In the initial phase, a metal post is inserted into the jawbone, serving as the implant. This post acts as a substitute for the root of the new tooth.
- After the implant is set in place, the surrounding bone goes through a healing process known as Osseointegration. This critical phase involves the fusion of the bone with the new implant, which typically lasts around two to six months.
- Once the healing period is over, a crown or artificial tooth is placed on top of the implant. This final step provides the patient with a new tooth that closely resembles the original and functions naturally.
What Makes a Dental Implant a Medical Necessity?
While dental implants are typically excluded from insurance coverage due to their classification as cosmetic surgery, reimbursement may be possible for individuals requiring implants for medical reasons rather than solely for cosmetic purposes.
Certain reconstructive dental procedures fall under insurance coverage. These include dental interventions such as tooth extractions and dental surgeries that address tooth fractures.
Dental implants may be recommended by dentists for various reasons, with the preservation of diseased teeth being a primary consideration. Even individuals with a history of good oral hygiene may face tooth decay, leading to the recommendation of dental implants.
How to Determine Medical Necessity
Dentists may ask specific questions to determine whether dental implants are medically necessary or not. Some of these include:
- Has the patient suffered a traumatic injury to the area?
- Is the condition the result of an infection, such as ulcers, diabetes, or GERD?
If patients can answer “yes” to one or both of these questions, they may be eligible for coverage. Ultimately, however, they will need to consult with their provider to confirm if the treatment will be covered.
What Determines Candidacy?
Not all candidates will be considered suitable candidates for this procedure. Some of the requirements include the following:
- Having a strong jawbone that can endure the healing process
- Having healthy gums
- Good oral hygiene (regular cleanings and dental checkups)
- Being a nonsmoker
- Being free of heart conditions or diabetes
What is the Takeaway?
In some cases, dental implants will be covered by insurance policies. Issues resulting from trauma or infections that require dental implants will usually be covered by these insurance plans. However, there are many factors to consider, and patients will need to reach out to their insurance providers to find out what can and cannot be covered.
Dr. Tara Hardin and the team at Hardin Dental are proud to provide patients with some of the most advanced dental implant techniques that Cincinnati has to offer. Contact us today to set up a private consultation and learn more about dental implants.
