Why are dental implants not covered by dental insurances?

Dental implants have a very poor history with dental insurances. In fact, as of today I have yet to hear from a dental insurance that covers dental implants.

Now before I dwell on this too much, lets look at an example of a dental insurance here in California: Delta Dental – a reputable insurance company. When it first opened its doors in the 1960s, it gave its members on the average a $1,000 yearly limit. Now, mind you this was in the ’60s. At that time you could have had pretty much your full mouth redone for $1000, considering that the average crown price was about $60 back then. Now guess what the average yearly limit is today, over 40 years later? If you guessed $1,500, you were right. And the average crown price?? Well it ranges on the average here in California between $600 and $1,200. Can we all see the discrepancy here?

Now the average single tooth implant (which includes the surgical placement of the implant, the abutment and the final crown) is between $3000 and $4,500 on the average (go my website to find definitions and images for these components). As you can see, the economical challenges would be immense for an insurance company to overcome.

If insurance companies actually did cover dental implants, like they cover other dental work, they would eventually force doctors to accept a much lower payout for their implant work. That is very difficult to do, because implants and all the associated surgical and prosthetic hardware are very expensive to manufacture and purchase. Accepting a lower fee for implant services will lead some practices to “cut corners” in order to protect their profit margins and that is exactly what you don’t want to do with dental implants. They are very technique sensitive devices, and success rates could be dramatically reduced, if inferior products are being used.

I therefore take the position that dental insurances and dental implants are dangerous mix that should not be attempted. Many patients have found other creative way to finance such expensive work, like Care Credit or flexible spending accounts.

Technorati Profile


2 Responses

  1. Dr. Gougaloff:

    You should know that while some of your basic ideas about the “limits” of dental insurance with respect to implants are correct, your basic premise that Delta Dental and other dental carriers do not cover them is incorrect.

    As of August 2007, Delta Dental began to cover dental implants – though only up to the patient’s annual maximum – which as you point out, does not actually cover the larger portion of the expense for the enrollee.

    Other dental carriers have begun to follow suit with this policy. Dental implants are generally covered at 50 percent, up to the annual maximum, with the patient responsible to pay the balance.

    The exception to this is with large self-finded groups in which the group contract is determined by the employer and may only allow a specified allowance toward the implant, equal to the amount that would have been paid towards a crown and bridge.

    Send me a reply if you have any questions about that. I’d be happy to forward you our news release from last year announcing the change, which we have made in all 15 states where we are the Delta Dental Plan of record.

  2. Dear Mr. Album,

    Thank you very much for your comment to my blog post. There is obvously a great deal of misinformation out there about this subject, especially when it comes to which part of the dental implant procedure is covered and which not (i.e. the surgical placement, the associated grafting procedures, the prosthetic abutment or only the crown).

    I would love to shed some light on this for the community, so any material or news releases you might have are greatly appreciated. I will certainly post such material and make it available to the readers.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: