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Does Insurance Cover Root Canal?

If you know your molars from your pre-molars, you’ll know that root canals can be a painful affair—and expensive. But how can dental insurance cover such medical procedures? We let you in on the tips and tricks.
Does Insurance Cover Root Canal?
This blog will cover everything about root canal procedures, their associated costs, and how dental insurance can help pay for treatment. It also examines dental insurance plans and ways to get the most from your coverage.
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Health insurance comes to your rescue whenever healthcare bills burn your pocket. Health insurance provides for several medical emergencies and illnesses. Regarding dental insurance, the question often is, does insurance cover root canal treatments?

This blog will cover everything about root canals, their associated costs, and how dental insurance can help pay for treatment. It also examines dental insurance plans and ways to get the most from your coverage. Let’s explore.

Understanding Root Canals and Their Costs

What is a Root Canal?

A root canal is a dental procedure to save a tooth that is severely decayed or infected. During the procedure, the dentist removes the infected pulp, cleans the inside of the tooth, and seals it. This process helps to eliminate the infection and prevent further damage, ultimately saving the tooth from extraction.

Signs You Might Need a Root Canal

Recognizing the signs that you might need a root canal can help you seek treatment promptly. Common symptoms include:

  • Severe toothache.
  • Prolonged sensitivity to hot or cold.
  • Discoloration of the tooth.
  • Swelling and tenderness in the surrounding gums.
  • A persistent or recurring pimple on the gums.

If you experience any of these symptoms, it is essential to consult with your dentist as soon as possible.

The Cost of Root Canal Treatment

National Average Cost

The cost of a root canal can vary widely depending on several factors, including the tooth affected and the complexity of the procedure. On average, root canal treatment costs between $700 and $1,500 per tooth. Molars tend to be more expensive due to their larger size and the complexity of treating them.

Factors Affecting Root Canal Cost

Several factors can influence the cost of a root canal, including:

  • Tooth Location: Molars are generally more expensive to treat than front teeth.
  • Geographic Location: Costs can vary significantly by region and city.
  • Dentist’s Experience: Experienced dentists may charge higher fees.
  • Complexity of the Case: More complicated cases requiring additional visits or specialized treatment can increase costs.
  • Additional Procedures: Costs may increase if additional procedures like crowns are needed post-treatment.

Read Related Article: What is Medicare: The Ultimate Guide.

Does Dental Insurance Cover Root Canals?

Now that we know what root canal is and what factors influence the pricing of a root canal. Let’s delve deeper into whether your insurance covers the cost of getting a root canal.  

Does Most Dental Insurance Cover Root Canals?

In many cases, dental insurance does cover root canals, but the extent of the coverage can vary based on the specifics of your plan. Understanding your insurance plan’s details is crucial to determining what portion of the cost will be covered.

Types of Dental Insurance Plans

PPO (Preferred Provider Organization)

PPO plans offer a network of preferred providers. You can visit out-of-network dentists, but staying within the network usually provides higher coverage and lower out-of-pocket costs. PPO plans typically cover a significant portion of the cost for major procedures like root canals after meeting the deductible.

HMO (Health Maintenance Organization)

HMO plans require you to choose a primary dentist within their network and generally do not cover out-of-network treatments. While they often have lower premiums and out-of-pocket costs, the choice of dentists is more limited. Coverage for root canals can vary, so it’s important to check if the procedure is covered under your specific plan.

Dental Discount Plans

Dental discount plans are not insurance but offer discounts on dental procedures. You pay an annual fee to receive reduced rates from participating dentists. These plans can help lower the cost of a root canal but typically do not provide as much financial assistance as traditional insurance plans.

Unpacking Your Dental Insurance Plan

Importance of Reviewing Your Dental Policy

Reviewing your dental policy is essential to understand what is covered and what is not. This helps avoid unexpected expenses and ensures you maximize your benefits.

Understanding Coverage Details

It’s crucial to comprehend the specifics of your coverage, such as:

  • What percentage of the root canal cost is covered?
  • Are there any waiting periods before you can receive coverage for major procedures?
  • What are the annual maximum benefits?

Key Terms: Deductible, Copay, Coverage Limits

  • Deductible: The amount you must pay out-of-pocket before your insurance starts covering the costs.
  • Copay: A fixed amount you pay for a service, with the rest covered by insurance.
  • Coverage Limits: The maximum amount your insurance will pay within a benefit period (usually annually).

Finding Your Dental Insurance Information

Policy Documents

Your policy documents are the primary source of information about your coverage. Review these documents carefully to understand the specifics of your plan.

Insurance Provider Website

Most insurance providers have online portals to access your policy details, coverage information, and other relevant resources. These portals can be beneficial for managing your plan and understanding your benefits.

Common Coverage Scenarios

Example 1: Basic Coverage and Root Canal

With basic coverage, your insurance may cover 50-80% of the cost of a root canal after you meet your deductible. You will be responsible for the remaining balance.

Example 2: Major Coverage and Root Canal

Plans with major coverage might cover up to 90% of the cost, leaving you with a smaller out-of-pocket expense. However, these plans often come with higher premiums.

Read Related Article: Cheap health insurance in Iowa.

Maximizing Coverage for Your Root Canal

Since root canals can be quite heavy on the pockets, it is necessary to maximize the coverage. Let’s take a look at how you can do so.

Communicate with Your Dentist

Communication with your dentist about your insurance coverage and financial concerns is vital. They can provide detailed cost estimates and help you navigate the insurance process.

Importance of Pre-Treatment Estimates

Requesting a pre-treatment estimate from your dentist and submitting it to your insurance provider can help you clearly understand what costs will be covered and what you will owe.

Understanding Pre-Authorization

Some insurance plans require pre-authorization for major procedures like root canals. Ensure you obtain this approval to avoid denial of coverage.

Ways to Reduce Out-of-Pocket Costs

Flexible Spending Accounts (FSAs)

FSAs allow you to set aside pre-tax dollars to pay for eligible medical expenses, including dental procedures. Using an FSA can help reduce your overall out-of-pocket costs.

Maximizing Annual Coverage Limits

Plan your dental treatments to maximize your insurance benefits. For instance, if you need multiple procedures, scheduling them across different benefit periods can help you fully utilize your annual coverage limits.

What if my Insurance Doesn’t Cover Root Canals?

What is the next best step if your insurance does not cover root canals? Let’s examine the alternatives. If your insurance does not cover root canals, there are several alternatives to consider:

Negotiating Payment Plans with Dentists

Many dentists offer payment plans to help spread the cost of treatment over several months. Negotiating a payment plan can make the expense more manageable.

Exploring Financing Options

Dental financing options, such as CareCredit, provide flexible payment terms and low interest rates, which can help you afford necessary dental treatments.

Conclusion

Understanding whether your dental insurance covers root canals and seeking maximum coverage would reduce your financial burden. You can ensure that through a review of the insurance plan, good communication from the dentist, and alternative means of financing, you receive treatment while keeping the costs in check. Check Beem, a marketplace where you can find various health insurance from top providers for all your needs. You can get everything you need in one place, whether searching for dental insurance, accident coverage, or short-term medical coverage.

Read Related Article: Does health insurance cover tummy tuck?

FAQs

Is a root canal covered by dental insurance?

Many dental insurance plans cover root canals, but the extent of the coverage varies. Reviewing your specific plan details is important to understand what portion of the cost will be covered.

How much does a root canal cost without insurance?

The cost of a root canal without insurance typically ranges from $700 to $1,500 per tooth, depending on factors such as the tooth’s location, the complexity of the procedure, and the geographic region.

Does a root canal hurt?

Modern root canal procedures are generally not painful, thanks to dental technology and anesthesia advances. Most patients report mild discomfort during and after the procedure, similar to getting a dental filling.

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Author

Picture of Raman Gujral

Raman Gujral

An achievement-oriented professional, Raman has 10+ years of experience in B2B SaaS and B2C products across Fintech, Telecom, Digital Media, Social Media and Logistics domains. Defining and communicating product vision and strategy, product roadmap development, product positioning, and data analysis, he is also an expert in health insurance and personal loans content.

Editor

This page is purely informational. Beem does not provide financial, legal or accounting advice. This article has been prepared for informational purposes only. It is not intended to provide financial, legal or accounting advice and should not be relied on for the same. Please consult your own financial, legal and accounting advisors before engaging in any transactions.

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