are dental implants covered by insurance? Archives

I have been considering getting dental implants, but what my friend is going through right now terrifies me. I’m seriously reconsidering it. She had her dental implants done more than a decade ago and has had no problems with them whatsoever. She’s one of the reasons why I wanted to get my own- she was always raving about them and has a great smile. Well, a few weeks back, she said she felt a lump on her gums beneath one, so she looked up the name of a local dentist and went in to get it checked. He said that her dental implant failed. Not only that, but she had an infection and bone loss, so she couldn’t just get a new one. It’s going to be a whole big thing for her. My dentist told me there was some risks, but that they were on the onset of treatment, not ten years down the road. What happened to hers and how can I be sure it doesn’t happen to me?

-Devon in Indiana

Dear Devon,

Your friend has what’s known as peri-implantitis and it’s rare. Usually, if someone is going to have an issue with theirs, it occurs early, during the healing phase or right after the porcelain crown is placed. Peri-implantitis can occur years down the line, often without the patient being aware that anything is happening at first, but there are some tell-tale signs, such as bad breath or a bad taste in one’s mouth, which both come from the infection. As the infection remains unchecked, the bone around it starts to dissolve away, causing big problems.

You said that your friend had to look up the name of a dentist. This is the first red flag. It means she probably wasn’t getting her regular checkups, which would have likely detected the problem much earlier. Additionally, she wasn’t getting her teeth cleaned, which probably means she had some form of gum disease, if not periodontal disease. When you go forward with dental implants, it’s imperative to get these checkups and cleanings, so you can be sure you’re maintaining your oral health. This story would probably not have ended the same way if she had done this.

There are a few other things that can signal someone might be at risk for peri-implantitis. Smokers are more prone to it, which may be because of the constricted blood vessels and the high incidence of periodontal disease seen in them. There are also other conditions related to healing and bone density that could cause trouble as well.

When you work with an experienced implant dentist, he’ll take these things into consideration and will tell you if you’re at risk for it and if you’re not a good candidate for dental implants. Between this and making sure your teeth and gums stay healthy, you’re well on your way to keeping your smile beautiful for many years to come.

I was in an ATV accident and lost both of my front teeth as a result. My dentist recommends dental implants and I’m all for it, but they said insurance isn’t going to cover much. Supposedly it’s cosmetic? I’m confused. Isn’t having teeth necessary? How on earth can they consider replacing them to be a cosmetic dentistry procedure? Is there a way to get insurance to pay more for dental implants?

-Randolph in Minnesota

Dear Randolph,

Yes, having teeth is necessary, especially if you like eating. It’s also important to get going on replacing them fast, because your remaining teeth will start to slide into the empty space they left behind. The problem is that most insurance companies recognize the need to replace them, but not to restore your smile with the best possible solution. Because there are less expensive methods that are, in their opinion, good enough, the better method is considered “cosmetic.” What they’ll generally do is cover the cost of a less expensive procedure, like a dental bridge, and have you pay the difference. Or they’ll pay for a just a portion of the dental implant, such as the crown that sits on top.

With that said, it doesn’t sound like your office requested a preauthorization or a predetermination of benefits from your insurance company. With larger procedures like this, it’s not a bad idea to have the office send off all the details to the insurance company and get them to officially state what they will and won’t pay for with your procedure. Depending on how your policy is written, you may have benefits that other plans don’t, or they may pay more for your treatment if they receive a letter from your dentist saying why the more expensive procedure is necessary. So, although dental implants are not really a cosmetic dentistry procedure, some insurance companies may process them as such because it means they’ll pay less.

Why Did My Friend’s Old Dental Implants Fail?

Why Is My Insurance Company Calling Dental Implants a Cosmetic Procedure?