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does dental insurance cover sedation?

Sedation dentistry is intended to make dental treatment far less stressful for the patient. If you have a dental phobia, get ill when you see a needle, or can’t cope with spending hours in your dentist’s chair in order to get your smile back in shape, sedation dentistry may be something you want to explore.

A word of warning though: don’t expect sedation dentistry to be covered by your dental insurance. The majority of dental insurance plans classify sedation dentistry as a luxury, optional procedure, along the same lines as dental implants or whiting treatments.

Costs for sedation dentistry vary depending on what sort of sedation you and your dentist decides to use, but you can expect to pay $150-200 for mild sedation to about $500 (and up) per hour for deeper “twilight” sedation. If you need general anesthesia though, (which is not technically considered to be sedation) your insurance may cover the cost as it is more likely to be a medically necessary part of the procedure.

Types of Dental Sedation

Sedation is a broad term that describes different levels of consciousness. The American Society of Anesthesiologists describes these levels as:

  • Minimal Sedation (Anxiolysis) is a drug-induced state during which an individual responds normally to verbal commands. Cognitive function and coordination may be impaired, but breathing and cardiovascular functions are unaffected.
  • Moderate Sedation / Analgesia ("Conscious Sedation") is a drug-induced depression of consciousness during which an individual responds purposefully to verbal commands. The patient can breathe independently, and cardiovascular function is usually stable.
  • Deep Sedation / Analgesia is a drug-induced depression of consciousness during which an individual cannot be easily aroused but responds purposefully to repeated or painful stimulation. The patient may not be able to consistently breathe on their own, but cardiovascular functions are usually unaffected.
  • General anesthesia is not considered sedation. During this drug-induced loss of consciousness, the patient is unresponsive, even to painful stimulation. The patient may not be able to breathe on his or her own, and basic body functions such as heart rate may be impacted and must be monitored constantly.

Sedation density may use any of these sedation levels, as well as general anesthesia. Typically, though a dentist will use minimal to moderate sedation for helping patients manage anxiety or get through long treatment processes.

When Does Insurance Cover Sedation Dentistry?

As noted above, general anesthesia may be covered by your insurance plan as it may be a medical necessity for a patient to be unconscious during the process. Talk to your dentist and/or whoever works with insurance providers at your dentist’s office. But make sure to talk to your insurance plan provider to confirm coverage, and get pre-approval if at all possible.

Sedation dentistry may also be approved if the patient has a medical condition or a disability that makes it impossible to receive proper dental care without being sedated. Some policies may cover a patient who has a medical diagnosis of a severe dental phobia. Again, check with your dentist and your policy provider.

Be aware though that most dental insurance policies only cover $1,000 to $1,500 in treatment costs, total, per year. The fee for your treatment, plus the cost of sedation, may be well over your policy’s coverage. If so, you may want to look into dental savings plans. While not all plans cover sedation dentistry, there is no annual coverage cap. This enables you to save 10% to 60% on the cost of your treatment, no matter how much the total is or how often you need to go to the dentist.

What Happens During Sedation Dentistry?

The process depends on what sort of sedation you’ll be receiving.

Your dentist may prescribe medication for you to take at home an hour before your appointment to manage anxiety and relax you. You’ll almost certainly want to bring a companion with you on the trip to and from the dentist’s office. You may be convinced that you can get there on your own, but you’re probably wrong. Get someone to drive or escort you.

Once you are at the dentist’s office you may receive more sedation, either orally (liquid or pill) or intravenously. You will likely receive local anesthetic painkillers as well, which will be injected or applied to your gums (some forms of sedation, such as nitrous oxide or “laughing gas,” help to manage anxiety very well but have limited pain-killing effects). Ask your dentist to detail the process for you so you know what to expect.

Afterwards, if you’ve had light sedation, you’ll probably be able to leave right after treatment is over. For deeper sedation, you’ll relax in the dentist’s chair or a recovery room until you’re ready to head home.

Mild to moderate sedation may leave you with no or very few memories of your time in the dentist’s chair. You’ll either wake up and it will all be over, or you’ll be somewhat aware of the process but entirely uninterested or perhaps amused about the whole thing.

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