If you have an severe tooth ache or other dental emergency, you likely have two questions. First, you will want to know how soon you can see a dentist and get relief. Second, you are probably wondering how much emergency dental treatment will cost you. While most medical insurance is designed to cover emergencies, most dental insurance is geared towards routine care and prophylactic treatment. This means that emergencies can result in high co-pays, even if you have dental insurance. However, dental insurance is starting to provide more thorough emergency coverage and here are the things you need to be aware of to make sure you pay the least amount possible for your emergency treatment.
What Constitutes a Dental Emergency
A dental emergency can range from a severe toothache to having a tooth knocked out or your gums severely cut. In these instances, it is important to get to a dentist right away in order to relieve your pain and prevent permanent oral damage.
Your dentist may refer to some procedures as an emergency, such as a root canal or the removal of your wisdom teeth. However, if these are not causing you immediate pain and are not threatening to your future health, your insurance may not cover emergency treatment of them. In this situation, you may have to develop a pain management plan and wait until you can see an approved dentist during business hours.
In-Network and Out-of-Network Dentists
When finding a dentist, one of the most important things you look for is someone who is in your insurance's network. This means that they have agreed to set prices for common procedures with your insurance. Most insurance plans cover little or no out-of-network treatment.
However, most plans do have partial coverage for out-of-network dentists when emergency treatment is needed. This may be a limited amount of money or may be a percentage of the procedure. Either way, you will end up paying less for an emergency dental care treatment if you avoid the emergency room, where dental costs are much higher than normal, and find an after-hours emergency dentist, even if they are not in your network.
When you go to an out-of-network provider, you may want to get as little work as done in order to ensure your oral health and reduce your pain. Then, you can make an appointment with an in-network provider the following business day. This will ensure that the majority of your dental work will be covered.
New Legislation Covering Dental Insurance and Emergencies
If you are concerned that your insurance provider may refuse to pay for emergency treatment that they deem unnecessary, you should follow House Bill 1002. This bill has been approved by the House of Representatives and is currently under examination in the U.S. Senate. It seeks to give more power to your dentist in making decisions regarding what constitutes a dental emergency and what the best treatment plan for you is.
If this bill passes, insurance companies will not be able to deny payment for emergency treatment simply because it was not pre-approved or the treatment was delivered the same day that a diagnosis was made, which should protect you in emergency situations.
In an emergency situation, your only concern should be ensuring your continued health. To avoid issues with your insurance, you should prepare for emergencies by reading your policy, finding an emergency dentist to work with, and knowing what is covered regarding out-of-network providers. However, if you currently have an emergency, you should contact an emergency dentist immediately and discuss possible sliding fees or payment plans to cover any necessary treatment.