Dental Coverage for Sedation Dentistry
In a dental clinic, patients may be able to go through sedation “for everything from invasive procedures to a simple tooth cleaning,” if they are afraid of the dentist, “have a low pain threshold,” “can’t sit still in the dentist’s chair,” “have a bad gag reflex,” “need a large amount of dental work completed,” etc. (“Sedation Dentistry: Can You Really Relax in the Dentist’s Chair?” 2018, 1-2). Dentists can offer different levels of sedation for patients, such as minimal sedation, moderate sedation, and deep sedation (“Sedation Dentistry: Can You Relax in the Dentist’s Chair?” 2018, 1). Depending on the level sedation, dentists provide different types of sedation as well, such as nitrous oxide with oxygen for inhaled minimal sedation and IV moderate sedation (“Sedation Dentistry: Can You Really Relax in the Dentist’s Chair?” 2018, 1). They could also provide general anesthesia, but this is usually not categorized as a sedation procedure (“Sedation Dentistry: Can You Really Relax in the Dentist’s Chair?” 2018, 1; “Is Sedation Covered by Dental Insurance?”). However, dental insurance companies may or may not include sedation dentistry in their policies.
Patients may receive dental coverage for sedation procedures, depending on their policies’ terms and conditions. Most policies usually do not cover sedation because they “classify sedation dentistry as a luxury, optional procedure,” and the procedures are expensive (“Is Sedation Covered by Dental Insurance?”; Roderick 2019). While some policies include benefits for mild sedatives, they usually do not include benefits for heavy doses for sedation (Roderick 2019). Beneficiaries that are “over a specific age or disabled” may be able to receive benefits for some sedation procedures (Roderick 2019). For people that just require general anesthesia, their “insurance may cover the cost as it is more likely to be a medically necessary part of the procedure” (“Is Sedation Covered by Dental Insurance?”) Patients could receive dental coverage for sedation needed for treatments, such as “filling a cavity or extracting a tooth” (“Sedation Dentistry Cost”). Some policies may provide coverage for sedation “if the patient has a medical condition or a disability that makes it impossible to receive proper dental care without being sedated” (“Is Sedation Covered by Dental Insurance?”). Also, while most policies usually do not “cover the cost of sedation to relax an anxious patient,” other policies could provide benefits to those with “a medical diagnosis of a severe dental phobia” (“Is Sedation Covered by Dental Insurance?”; “Sedation Dentistry Cost”).
Dental insurance policies may cover sedation, but not all of them provide coverage for those types of procedures. Even so, people can enroll into a more expensive policy that provides benefits for sedation dentistry or “a plan that is tailor made for this type of dentistry” (Roderick 2019). Patients should try to “get pre-approval” or pre-determination for any sedation procedures (“Is Sedation Covered by Dental Insurance?”; Tripulas 2018).