When I recommend a significant treatment like a dental implant to replace a missing tooth, or LANAP® laser surgery to save teeth from severe gum disease, my patients usually ask the exact same question: “Will my insurance cover this?”
It is a great question. Unfortunately, dental insurance is not always straightforward when it comes to advanced procedures. As a dentist, I want you to focus on getting your smile healthy, not stressing over confusing benefit packets.
Here is a simple breakdown of how most insurance plans handle high-level restorative and periodontal care.
Understanding the “Class III” Category
Most traditional PPO dental plans use the 100-80-50 Rule to determine how much they will pay.
- They pay 100% for preventative care (cleanings).
- They pay 80% for basic procedures (fillings).
- They pay 50% for major restorative care.
Dental implants and periodontal surgeries (like LANAP) fall into this “Major Restorative” or “Class III” category. This means your insurance will typically cover 50% of the allowable cost, and you are responsible for the remaining 50%.
How Implants Are Covered
Implants can be tricky because insurance companies often view them as two separate procedures: the surgical placement of the titanium post, and the porcelain crown that goes on top (which we scan for using our digital Medit i700 or Trios 3 scanners!).
Some older policies still classify the surgical post as a “cosmetic” upgrade and won’t cover it, but they will cover 50% of the crown. However, as implants become the gold standard for tooth replacement, more and more insurance plans are starting to cover both phases.
How LANAP® Laser Surgery is Covered
If you have advanced periodontitis, Dr. Habib will likely recommend LANAP laser surgery. Because this is a medical necessity to treat active disease and prevent tooth loss, most dental insurance plans provide coverage for it under their periodontal treatment benefits, typically at that 50% or 80% mark depending on your specific plan.
The “Annual Maximum” Catch
Even if your insurance covers 50% of your procedure, you have to watch out for your Annual Maximum. This is the hard cap on what your insurance will pay for the entire year (usually around $1,500 to $2,000). If your treatment exceeds that cap, the rest is out-of-pocket.
Before we start any major treatment at Leesburg Dental, our billing team will run a complete complimentary benefits check. We will give you an estimate of what your insurance covers, and if there is a gap, we can help you find ways to pay with flexible financing options like CareCredit.
Want to learn more about how we handle billing? Check out our complete guide to Understanding Your Dental Insurance, or call us at (703) 777-2442 to have us verify your specific benefits!
