Are Root Canals Covered by Dental Insurance?
Many insurance companies cover root canal treatment, though whether they cover the treatment depends on:
- Why the treatment is needed
- Who is performing the procedure
How much an insurance company pays toward endodontic treatment depends on multiple factors, all of which are (or should be) outlined in the written policy provided by the insurance company.
Terms You Need to Know
The following are a few of the factors that will impact how much a dental insurance company will contribute toward root canal therapy.
- Deductible: Every year, patients will need to pay a deductible before the insurance company pays any part of their dental treatment costs. Deductibles can range from $100 to over $2,000 depending on the insurance company, coverage, and whether the patient has an individual or family plan. Once the deductible has been met, the insurance company will start to pay its portion of dental costs.
- Co-pay: Most insurance companies only cover a percentage of treatment costs. Many (but not all) pay 100 percent toward diagnostic and preventative procedures (up to the annual maximum). For restorative procedures (fillings), coverage is often around 80%, meaning the patient must pay for 20% of the procedure. Major procedures (crowns, dentures) are often covered at 50%. It is important to note that not all insurance plans stick to this percentage breakdown. If they choose to pay less, the patient is responsible for the difference. Root canals are typically covered at 50% to 80%.
- Coverage terms: Some policies do not cover root canals. Instead, they only cover diagnostic and preventative procedures (cleanings, exams). It is important for patients to carefully read through insurance documentation and review the coverage terms, so they are not surprised when it is time to pay their dental bill.
- Dual insurance coverage: Some patients are fortunate enough to have dual insurance coverage. In this instance, the primary insurance company will pay their percentage and the supplementary insurance company will pay the balance or a percentage of the balance. Patients should discuss their policies with their insurance company and their endodontic team to determine what, if any, co-pay amount they will be responsible for paying.
- Waiting period: A few insurance companies will start paying for diagnostic, preventative, and even basic restorative procedures as soon as a policy is activated. However, when it comes to major dental procedures, they may have a waiting period of six to 12 months. During this period, the patient is 100% responsible for the cost of any major restorative treatments.
- Maximums: In addition to coverage percentages and deductibles, patients also need to be aware of another number: their annual maximum. Depending on the company and policy, maximums can range from $500 to $2,500. Once an insurance company has covered their percentage of costs up to the maximum amount, the patient is then fully responsible for any remaining treatment costs.
- Preauthorization/Prior Authorization: Before considering payment, some insurance companies require a preauthorization. This form is like a typical claim form except that it is sent before the procedure is performed. Based on the insurance company’s response to the preauthorization claim, the endodontist can provide the patient with an even better idea of how much of their dental bill they will need to pay.
- Claim denial: Insurance companies reserve the right to deny claims based on certain factors. These can range from a procedure being done before the waiting period ended, the procedure performed not being a covered benefit (a night guard for TMJ, for example), or the company viewing the procedure as elective and not a dental necessity (for instance, veneers for aesthetic purposes). In some cases, your endodontist can fight a claim denial by resubmitting a claim with more details, including diagnostics, chart notes, and information provided by a dentist’s second opinion.
Does Your Endodontic Provider Accept Your Insurance?
Another factor to consider is whether your endodontic provider accepts your insurance. You may have the lowest deductible, highest maximum, and best percentage of coverage for procedures, but if your provider does not work with that insurance company, you will still be responsible for the majority (or all) of costs.
Dental providers are not required by law to work with all insurance providers.
Renovo accepts PPO plans and most HMO plans. Our team will work with you and your insurance company to provide you with the best treatment, an as-accurate-as-possible treatment plan estimate, and affordable costs.
Other Payment and Coverage Options
Root canal therapy is one of the best treatment options for preventing tooth loss. And oftentimes, it is done on an emergency basis due to trauma or infection.
We understand how stressful unexpected costs can be and want to help alleviate as much stress as possible. That is why we offer an outside financing option to help patients who do not have insurance or who need assistance paying their copayments and deductibles. Talk to our team to learn more!
Renovo Endodontic Studio: Giving You All the Information You Need
For most people, the decision-making process is not an easy one. We want to help, which is why our team of diverse endodontists and compassionate assistants will go the extra mile when it comes to determining your treatment costs.
When you visit one of our offices, our team will take the time to contact your insurance to verify your benefits/coverage and provide you with the most accurate co-payment estimate possible. Our team will also discuss payment options and outside financing.
We understand that dental care is not a cheap investment. However, we know that when you invest with Renovo, you receive the highest-quality endodontic care, which can provide you with pain relief and peace of mind.
Do you still have questions about endodontic costs? Contact our team. We’re happy to address your concerns right away.