Will Your Dental Insurance Cover an Urgent Emergency Visit?

March 21, 2024

Filed under: Uncategorized — tntadmin @ 11:30 am
A patient looking at a dental insurance form

A dental emergency is a hard thing to handle alone. After all, it’ll leave you worrying about lost teeth, ruined smiles, or worse. That said, you also shouldn’t have to worry about whether insurance can foot the bill. Luckily, it’s easy to address that concern before your trip to the dentist. To that end, here’s a primer on why dental insurance can cover an emergency visit.

Don’t Forget the 100-80-50 Rule

Most dental plans do cover urgent oral care. In fact, they tend to view emergency dental work as a vital expense. However, your plan will likely require you to meet a deductible or co-pay. Coverage for dental emergencies often sticks to the 100-80-50 rule. That means covered treatments fall into three categories:

  • Preventive Services – Dental insurance almost always covers preventive work at 100%. The latter services include dental checkups, teeth cleanings, oral X-rays, etc.
  • Basic Procedures – Insurance will often cover 80% of a basic procedure’s price. That rate applies to dental fillings, root canals, and simple extractions.
  • Major Procedures – Dental restorations like bridges and implants get the least coverage. These major procedures usually only have 50% of their cost covered.

In a dental emergency, the relevant treatments are often basic and major procedures. Thus, a dental insurance plan will likely cover much of the cost.

Confirm Your Dental Plan’s Type

If you didn’t know, most dental plans are either PPOs or DHMOs. You can see dentists in and out of network with a PPO, but the co-pay is lower for in-network practices. In contrast, you can only visit an in-network dentist under a DHMO. Any dental care outside the network won’t qualify for coverage.

Given these facts, you’d be wise to note your plan’s type alongside the 100-80-50 rule. Your urgent care will cost more or less depending on the specific dental insurance.

Other Financing Options Exist

Even if your insurance isn’t great, other ways exist to finance urgent oral care. Just look at a given dental practice’s payment options; they can make your emergency visit budget-friendly.

For instance, see whether a dentist offers flexible financing. Many dental providers now allow patients to work with third-party financiers. Using such groups, you could pay for your dental emergency through monthly installments. That setup lets you slowly meet the cost of care instead of all at once.

Urgent dental care is always worthwhile, but even more so if you have a dental plan. Your dental insurance really can cover an emergency visit. So, don’t hesitate to consult your dentist for more precise details.

About the Practice

Comal Dental is based in New Braunfels, TX. Led by Drs. Haag and Hansen, our practice wants each patient to achieve their dream smile. We help you reach that goal by offering preventive, cosmetic, and restorative services, as well as emergency oral care. Our dental team will always be ready to assist your teeth and gums! For more details or to book a visit, you can reach us on our website or by phone at (830)-625-1515.

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