Periodontal care sits in an awkward corner of most dental plans. Cleanings and exams are usually well covered, gum treatment is often covered at a percentage, and implants vary enormously from one policy to the next. Our job is to tell you what your specific plan will do before you agree to treatment, so there are no surprises when the statement arrives.
We verify your benefits for you
Once we have your plan information, our team contacts your insurer and confirms your annual maximum, remaining balance, deductible, waiting periods, frequency limits on periodontal maintenance, and whether implants and bone grafting are covered benefits under your policy. We then give you a written treatment estimate showing what your plan is expected to pay and what your share is likely to be.
How the main categories usually work
- Diagnostic and preventive. Exams, x-rays, and cleanings are typically covered at the highest percentage, often with frequency limits per year.
- Periodontal therapy. Scaling and root planing and periodontal maintenance are commonly covered at a mid-tier percentage, frequently with a limit on how often maintenance visits are payable.
- Surgical periodontal care. Gum grafting, pocket reduction, and crown lengthening are usually major services, often subject to a deductible and a waiting period on newer policies.
- Implants and bone grafting. Coverage ranges from generous to none at all. Some plans cover the surgical placement, some only the crown, and some exclude implants entirely but pay an allowance equivalent to a bridge.
Pre-treatment estimates
For larger cases we can submit a pre-treatment estimate, sometimes called a predetermination, to your insurer. They respond in writing with what they will pay. It takes a few weeks, and it is the single most reliable way to know your out-of-pocket cost in advance. For staged implant treatment we will also tell you which parts of the plan fall in this benefit year and which fall in the next, since splitting treatment across two years can make better use of two annual maximums.
If you have medical insurance too
Some procedures with a medical component, such as treatment following an injury, biopsies, or certain bone grafting in combination with a medical diagnosis, may be billable to medical insurance. Bring your medical card and we will tell you whether it applies in your case.
Payment and financing
Benefits rarely cover the full cost of comprehensive periodontal or implant treatment. We accept major credit cards, and we can discuss third-party financing options that spread payment over time. Ask us before treatment is scheduled and we will build the plan around your budget as well as your diagnosis.
Talk to us first
Every policy is different, and the summary above is general. Call 720-676-1231 with your plan details and we will tell you what your coverage does.