Insurance Coverage for Sedation Dentistry: What You Must Know

Right now, every dollar in your budget counts. You naturally want to make sure you’re getting full value from the money you already spend on your insurance benefits. However, when it comes to dental care, a huge number of people are afraid of visiting the dentist or think avoiding these appointments will save money. If you would like to take advantage of sedatives like nitrous oxide or oral conscious medication for checkups or more advanced treatment, you may wonder whether dental insurance will cover anything for sedation dentistry. Generally, the answer is no, but there are a couple of exceptions.

Reason for Coverage #1: You Have Been Officially Diagnosed with Anxiety.

There is a difference between feeling a little nervous about your dental visit and actually having a recognized anxiety disorder. Although mild sedation can manage your nervousness and help you have a better experience, if you have a documented history of anxiety, your insurance may recognize that this sedation isn’t elective but necessary for you to undergo essential dental care.

Reason for Coverage #2: You Have Developmental or Physical Disabilities.

In addition to easing fears, dental sedatives also calm the body, keeping it more still, which is especially helpful for those who find it difficult to sit in one place for extended periods of time. Patients with special needs, developmental issues, or physical medical conditions or disabilities may require sedation to sit still and endure treatment more comfortably. In these cases, sedation can be considered “medically necessary,” and dental insurance may pay for part of the cost.

Keep in Mind about Sedation Dentistry

Whether the above reasons apply to you or not, here are some tidbits to remember and do when getting sedation dentistry:

• Check your coverage with your insurance company. It is possible it offers more limited or more generous benefits based on your specific plan.
• Let your dentist’s office know that you’d like to use sedation during your next appointment beforehand. If you require a prescription for oral conscious sedation prior to your arrival, you can pick it up from the pharmacy and take it in advance according to your dentist’s instructions.
• Ask if you need to bring any documentation to substantiate medically necessary sedation for insurance claims.
• Be prepared to pay at least a part of the total cost, even if you qualify for coverage. Most plans only have about $1,500 coverage available per year, and you may not have enough funds left to get it entirely paid for by insurance.
• Delaying dental care or avoiding the dentist (out of fear or worries about money) increases your risk of developing severe problems that can cost thousands of dollars to fix.

You may feel the economic pinch on your budget already, but if sedation will make it possible for you to get dental treatment you need, but you don’t qualify for insurance coverage, it may be worth paying a couple hundred dollars out-of-pocket to get it. Keeping your oral health on track can help your overall health and save you money in the long run.

About the Practice

From our dentists to our front desk team, assistants, and hygienists, Applegate Dental prioritizes patient comfort at every appointment. In addition to offering sedation, we make a concerted effort to create a welcoming, pleasant environment to visit. Our friendly front desk staff members start with a warm greeting, and we are determined to help you feel safe, well cared for, and appreciated. If you would like to use sedation at your next appointment, please let us know when you schedule it. Contact us online or call our West Seneca office at 716-668-4646.