A Answers (3)
The answer is not simple and depends on several factors. The first is whether your benefit plan has a specific line item that includes implants. If it does this does not guarantee that you will receive benefits for implants since this procedure is subject to claim review. A dental consultant will review the claim to determine several factors. Was the tooth lost during your enrollment in the plan or prior to being enrolled (missing tooth clause), in the latter situation there are no benefits. Are there other missing teeth in the arch... if so can a denture be used to replace the teeth (this is an example of an alternate benefit clause). Does the benefit include implant placement or does it only include implant restoration? In this case the patient pays to have the implant placed and would receive benefits when the implant is restored (crown or denture placed on the implant). Every case is different so the recommendation would be to have examinations by the doctor placing the implant and by the doctor restoring the implant (this may be the same doctor). Ask to have your insurance benefit predetermined (unfortunately that still does not guarantee payment). You will then have a better understanding as to YOUR costs for YOUR treatment.