Removing Teeth & Dental Insurance
Many types of dental insurance exist: indemnity plans, DHMOs, fee-for-service plans among them. A dental plan may or may not cover tooth extractions. Each plan varies according to company, and also according to the schedule of benefits outlined by your individual or group plan.
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Indemnity Plans
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Most indemnity plans consider extractions a "basic" service. They are included with periodontal services, fillings (restorative), and sometimes root canals. The plan pays 80 percent of costs when the extraction is considered basic, and up to 50 percent when it's considered "major." The type of extraction may dictate which category it falls under, with more difficult extractions being considered a major service.
PPO
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Preferred Provider Organizations (PPO) may or may not cover extractions, or may limit the benefit to "simple extractions" (not requiring surgery and with only the use of forceps). The standard PPO will cover all extractions at 80 percent, but only when you see a "preferred" doctor. The 80 percent of other doctors' "usual, customary, and reasonable" fees (UCR) will not necessarily be paid.
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DHMO
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Dental Health Maintenance Organizations (DHMO), where certain dentists are paid a monthly fee to see all patients in an area (regardless of treatment needed), can vary greatly. Almost all will cover simple extractions or surgical extractions with a co-pay from the patient. Almost none will cover "full bony" impacted extractions or the services related to those extractions. Most impacted extractions are "wisdom teeth," clinically referred to as "first molars."
Adjustment of Benefits
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When you purchase individual dental plans, it's easy to find out if extractions are covered. When you are provided with a group plan, the employer may have adjusted benefits to lower costs. In this case, extractions may be covered only as "major" (with payment at 50 percent), or extractions have been excluded from the plan altogether.
Replacement Clause
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Bear in mind that when a tooth is extracted on one policy, and you want to replace the tooth later on when you have another policy, 90 percent of dental insurances have a "missing tooth clause" or "replacement clause." The new insurance, even if the policy is from the same company, is not obligated to pay for the bridge, denture, or implant (rarely covered anyway) needed to replace the tooth.
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- Photo Credit Image by Fotolia.com, courtesy of Dragan Bombek
