Is Periodontal Treatment Covered by Medical or Dental Insurance?

What is Periodontal Treatment?

Periodontal disease, also known as gum disease, affects millions of people every year. Community Shores Dental can effectively treat this condition for our patients in Norton Shores, MI, protecting their teeth and overall health. However, figuring out whether periodontics is covered under medical or dental insurance can be confusing. We’re often asked, “Does health insurance cover procedures like periodontal treatments?” So, we’ll provide some clarity here. Read further to learn more about periodontal disease, insurance coverage, and alternative payment options.

What Is Periodontal Disease?

Periodontal disease is a severe gum infection caused by bacteria. It begins as gingivitis, which is mild gum inflammation, and can progress to periodontitis if left untreated. The team at Community Shores Dental is committed to helping our patients maintain healthy gums. This can also improve overall health because advanced periodontal disease can lead to heart disease, diabetes, and even pregnancy complications. We can protect you by performing deep cleanings, scaling and root planing, and periodontal abscess treatment. So, let us know if you notice any of the following:

• Persistent bad breath
• Swollen or bleeding gums
• Loose teeth
• Gum recession
• Painful chewing

Medical vs. Dental Insurance Coverage

Insurance coverage for periodontal treatment can vary greatly. Generally, dental insurance mostly covers oral health procedures, while medical insurance focuses on general health conditions. Here’s how the two typically work for periodontal treatment:

• Dental Insurance– This often covers routine cleanings, partial periodontal disease treatment, and related procedures like scaling and root planning.
• Medical Insurance – Providers may consider coverage for periodontal treatment if it’s deemed necessary for a broader health reason, such as managing diabetes or preparing for heart surgery.

Factors Affecting Insurance Coverage

Not all patients will qualify for medical insurance coverage for periodontal treatment. Understanding your plan and its guidelines is crucial. Some factors that may affect your coverage eligibility include:

• Health Connections – If there’s a direct link established between your gum disease and a medical condition, your treatment may qualify.
• Policy Details – The specifics of your dental and medical insurance plans will play a big role in determining coverage.
• Type of Procedure – Some procedures, like removing affected tissue or periodontal abscess treatment, may qualify for medical insurance under certain circumstances.

Navigating Insurance Coverage

Navigating the complexities of dental and medical insurance can feel overwhelming, especially when trying to determine what’s covered under each policy. Here are some tips to simplify the process:

• Call Your Provider – Contact your insurance provider to ask specific questions about periodontal treatment, coverage limits, and exclusions.
• Request a Pre-Determination – Before undergoing treatment, ask our dental office staff to submit a pre-determination to your insurance company to confirm coverage.
• Get a Medical Referral – In cases where medical coverage might apply, it will help to have a referral from your primary care provider tying periodontal issues to another condition.

Is Periodontics Covered Under Medical or Dental Insurance?

The million-dollar question is whether periodontal treatments are covered under medical or dental insurance. The answer will depend on the specifics of your situation. Always consult your insurance companies and providers for clarity. Most medical insurance plans don’t cover routine dental care. However, periodontal disease treatment may be an exception when it directly impacts overall health. For instance, if your gum disease is tied to a health condition like diabetes or heart disease, it may qualify for medical insurance support.

On the other hand, periodontal treatments like gum cleanings, antibiotics, and surgery to restore gums usually fall under dental insurance.

Other Ways to Pay for Periodontal Treatment

When insurance falls short, there are alternative payment options to consider that may make treatment accessible. They include:

• Health Savings Accounts (HSA) or Flexible Savings Accounts (FSA) – These can often pay for dental treatments with pre-taxed earnings.
• Payment Plans – Ask our staff about payment plans to help spread the cost of treatment over time.
• Dental Discount Plans – A membership program offering reduced rates on dental procedures may also be an affordable option.

Contact Us for Help Understanding Insurance

Community Shores Dental is committed to ensuring your periodontal treatment is effective and accessible. We’ll happily help you navigate insurance options, so rely on us for expert gum care in Norton Shores, MI. Contact us today to learn more or schedule an appointment.