Will My Insurance Cover Sedation Dentistry?

Many dentists and specialists choose to offer sedation; they want patients to have a comfortable and easy treatment experience! As you prepare for your next dental appointment, you might wonder if sedation is right for you. Moreover, you may be curious about whether your insurance plan will cover this part of your visit. Should you expect your policy to apply to sedation, or will you be required to pay out of pocket? This blog post explains some relevant information.

Sedation Is Often Viewed as Elective

Insurance policies vary widely, and coverage for dental sedation differs from plan to plan.  In most cases, sedation is viewed as elective, meaning that coverage is not provided. However, there may be some exceptions.

For example, coverage is more likely if:

• You have a documented medical condition that makes it difficult for you to receive dental care without sedation. Many special needs patients fall into this category.
• You need to undergo a complex procedure, or you are undergoing multiple procedures in one appointment. (By increasing the efficiency of your care, sedation might help to keep costs lower for your dentist and insurance company.)
• You will receive one of the more conservative types of sedation, such as oral conscious sedation.
• Due to various factors, sedation is a medical necessity for your particular case.

How to Find Out if Coverage Is Available

To find out if your insurance covers dental sedation, start by reviewing your policy’s details. Look for sections addressing sedation or anesthesia. If the information is missing or unclear, contact your insurance provider directly. Speaking with a representative will enable you to get specific insight into how your benefits work.

Additionally, discuss your sedation needs with your dentist. Their team may be able to help get preauthorization for coverage from your insurance company.

What if Your Insurance Will Not Cover Sedation?

If your dental insurance will not cover sedation, you may choose to pay out-of-pocket for it. This is a good choice if treatment would be extremely uncomfortable or even impossible for you without some sort of medication to help you relax. You can also talk to your dental team about payment options; they may be able to help you apply for low-interest financing.

If you decide to forgo sedation, you can still be confident that your dental team wants you to be comfortable. They will use local anesthesia to numb your mouth, and they can take extra care to be gentle when performing your procedure.

Insurance does not always cover sedation, but it is worth looking into your policy to find out how it might apply!

Meet the Practice

Dr. Kenneth J. Canzoneri is an experienced general dentist who is proud to offer oral conscious sedation to help patients enjoy a more comfortable care experience. If you have questions about sedation or the other methods we can use to help you relax in the treatment chair, contact our Arcadia office at 626-446-1679.