Dental Implants Now a Covered Benefit
ODS is pleased to announce that over the next year dental implants will become a covered benefit under many of our dental plans. This change will take place as groups renew their contracts. Please note that some groups may elect not to offer this benefit. Implants have long been the subject of many clinical trials. The industry consensus is that they are a viable and often preferable way to replace missing dentition, and most people can benefit from the stability and comfort offered by implants.
Implants and implant restorations will be reviewed by ODS dental consultants for long-term prognosis. Contraindications may include previous implant failure in the site, inadequate vertical bone, inadequate bone density or defects, advanced periodontal disease, inadequate vertical dimension, or proximity to a sinus cavity or inferior alveolar nerve canal.
In all cases, the final restoration benefits or alternate benefits are not provided if the tooth, implant or tooth space received a cast restoration, including a pontic or prosthodontic benefit within the previous five years. For example, if a tooth received a crown two years ago and now requires an extraction, the implant placement will be covered. However, the final crown and abutment will not be covered because of the previous benefit given for the crown two years ago. Please note: Implant-supported bridges are never covered if one or more of the abutments is supported by a natural tooth.
Typically, implant maintenance services will be covered, as will services to support the placement of implants, such as bone grafts and sinus lifts when medically necessary.
Dentists who have not filed fees for implant services should do so at their next filing opportunity. Fees can be filed online through our website.
To see if a patient has implant coverage, simply sign on to Benefit Tracker, pull up your patient’s information and access Group Limitations. If the benefit change has taken effect, a note indicating “Plan has standard implant benefit” will have been added. Groups renew at different times of the year, although most renewals take place in January, July and October.
Standard benefits will include the following:
- Surgical placement and removal of implants, with the benefit limited to each service once per lifetime per tooth space
- Final crown and implant abutment over a single implant
- Final implant-supported bridge abutment and implant abutment, or pontic
- Alternate benefit per arch of a conventional full or partial denture for the final implant-supported full or partial denture prosthetic device