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Will My Dental Insurance Cover an Emergency Visit?

February 11, 2021

Filed under: Uncategorized — drsaran @ 12:57 am
woman in pain calling dentist in Long Island City

Dental emergencies are stressful enough on their own. When one strikes, the last thing you want to worry about is whether your dental insurance will provide coverage. Instead of waiting until the last minute to find out, a dentist in Long Island City provides some insight so you’ll be prepared and have one less issue to contend with.

The Different Types of Plans and Their Structures

The first thing to know about dental insurance plans is that they are typically far less complicated than medical insurance. Here are the most common options:

  • Preferred Provider Organization (PPO) – This model comes with a list of dentists who accept the PPO plan. You can choose a provider who is out of network, but the out-of-pocket cost will be higher.
  • Dental Health Maintenance Organization (DHMO) – Similar to a health insurance HMO, the DHMO includes a list of dentists who accept the plan for a select co-pay, and in some cases, there is no fee. However, you may not be able to visit an out-of-network dentist.  
  • Discount of Referral Dental Plan – With this model, there is a discount on dental services from a select group of dentists. It should be noted that with this plan, there is no coverage provided. Instead, dentists who participate have agreed to offer their services at a discounted rate.

What the Plans Cover

Because all dental insurance plans differ, the best way to determine what is covered is to review the specific details. The PPO and DHMO plans will typically cover, in different percentages, the cost of preventive care, fillings, crowns, root canals and certain oral surgeries. Treatment will usually fall under the category of preventive, basic and major, with coverage disbursal as follows:

  • Preventive – Typically, semi-annual cleanings and checkups are 100% covered.
  • Basic – This applies to fillings, gum disease treatment, tooth extraction and root canal therapy. Dental insurance will usually cover up to 80%.
  • Major – If you’re in need of an inlay, replacement crown or dentures, it will usually be classified as major care, with up to 50% of the cost covered.

Most plans will provide some form of coverage for a dental emergency. The limit will depend on the type of treatment you need, how it’s classified and the specifics of the plan.

Ultimately, by taking the time to research the details of your dental insurance plan, you can eliminate any guessing. Then, based on what you discover, you can make any needed changes. The more proactive you are, the less stress you’ll have to endure if a dental emergency strikes, and the sooner you can get back to leading a normal and pain-free life.

About the Author

Dr. Ishwinder Saran earned his dental degree from the Boston University Goldman School of Dental Medicine. An experienced and highly skilled professional, he offers comprehensive dental care, which includes emergency dentistry, root canal therapy, and other minor surgical procedures. To further expand his skillset, Dr. Saran has taken several hours of continuing education, and he has received training from the renowned Spear Education. He combines his years of experience and advanced training to help his patients recover from dental emergencies at LIC Dental Associates, and he can be reached for more information or to schedule a visit through his website.

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