Coverage Details
Delta Dental insurance provides coverage for dental implants, which are artificial tooth roots that are surgically placed in the jawbone to support a dental prosthesis, such as a crown, bridge, or denture.
The coverage for dental implants varies depending on the specific Delta Dental plan. However, most plans cover the following:
Types of Dental Implants Covered
- Endosteal implants: These are the most common type of dental implant. They are surgically placed in the jawbone and fuse with the bone over time.
- Subperiosteal implants: These implants are placed on top of the jawbone, beneath the gums.
- Zygomatic implants: These implants are used to support dental prostheses in patients who have lost a significant amount of bone in the upper jaw.
Procedures and Treatments Included
- Implant placement surgery
- Abutment placement surgery
- Crown, bridge, or denture placement
- Bone grafting (in some cases)
Limitations and Exclusions
Delta Dental insurance may have certain limitations or exclusions related to implant coverage. These may include:
- Coverage may be limited to a certain number of implants per year.
- Coverage may not include the cost of preparatory procedures, such as tooth extractions or bone grafting.
- Coverage may not include the cost of maintenance or repairs to implants.
Cost and Benefits
Dental implants are a long-term solution for missing teeth, but they can be expensive. The average cost of a single implant, including the abutment and crown, ranges from $3,000 to $5,000. This cost can vary depending on the complexity of the procedure, the materials used, and the location of the dental practice.
Delta insurance can help reduce the financial burden of implant treatment. Many Delta plans cover a portion of the cost of implants, typically between 50% and 80%. This coverage can save you thousands of dollars on the overall cost of your treatment.
Additional Benefits
In addition to coverage for the cost of implants, Delta insurance may also offer other benefits, such as:
- Discounts on dental services, including implants
- Access to a network of preferred providers who offer lower rates on implants
- Reimbursement for the cost of travel and lodging if you need to travel for implant treatment
Eligibility and Requirements
Delta Dental’s coverage for dental implants is subject to certain eligibility criteria and requirements. To be eligible, you must have a comprehensive dental plan that includes coverage for major restorative services. Additionally, you must meet the following requirements:
- You must have a valid dental exam and X-rays within the past six months.
- Your dentist must submit a pre-approval request to Delta Dental for your implant treatment.
- Your pre-approval request must be approved by Delta Dental before you can receive treatment.
Documentation and Paperwork
To submit a pre-approval request, your dentist will need to provide the following documentation:
- A detailed treatment plan outlining the proposed implant procedure.
- A panoramic X-ray of your mouth.
- A periodontal examination report.
- A medical history questionnaire.
Once Delta Dental has received and reviewed your pre-approval request, they will make a decision within 30 days. If your request is approved, you will receive a letter of approval that Artikels the coverage details for your implant treatment.
Provider Network and Coverage
Delta Dental offers a comprehensive network of experienced and qualified dental providers who specialize in implant services. These providers have undergone rigorous training and have a proven track record of success in implant placement and restoration.
To find and select a qualified provider within the Delta network, you can use the online provider directory or contact Delta Dental directly. The directory allows you to search for providers by location, specialty, and other criteria. You can also read reviews from other patients to help you make an informed decision.
Out-of-Network Coverage
Delta Dental generally does not cover services provided by out-of-network providers. However, there may be exceptions in certain circumstances, such as if you are unable to find a qualified provider within the network or if you have a pre-existing relationship with an out-of-network provider. In these cases, you may be able to obtain coverage for out-of-network services by submitting a prior authorization request to Delta Dental.
Comparison with Other Insurers
Delta insurance coverage for dental implants generally compares favorably to that of other major insurance providers. It offers competitive coverage limits, including both surgical and restorative costs, and a wide network of participating providers. However, there are some areas where Delta may fall short compared to competitors.
Unique Benefits and Advantages
One unique benefit of Delta insurance is its focus on preventive care. Delta offers a range of preventive services, such as regular cleanings and checkups, which can help to prevent the need for more expensive dental procedures, including dental implants.
Another advantage of Delta insurance is its strong network of participating providers. Delta has a large network of dentists and specialists who are experienced in placing and restoring dental implants. This means that Delta members can easily find a qualified provider who can provide them with the care they need.
Areas Where Delta May Fall Short
One area where Delta insurance may fall short compared to competitors is in its coverage limits. While Delta offers competitive coverage limits for dental implants, some other insurers may offer higher limits. This could be important for patients who need more extensive treatment or who have a higher risk of complications.
Another area where Delta may fall short is in its out-of-network coverage. Delta’s out-of-network coverage is limited, which means that patients who see a dentist who is not in Delta’s network may have to pay a higher percentage of the cost of their treatment.
