Tag Archives: sedation dentistry insurance

Should I have to pay for sedation dentistry again?

In May I got a new partial denture and I think I’m going to have to go back under sedation to have it fixed. A metal clasp on the left side of my mouth is putting a lot of pressure on the next tooth. I thought that maybe it would loosen with time but it’s quite uncomfortable. Can this clasp be adjusted? If it can be, should I have to pay out of pocket for sedation dentistry? I’ve used all of my insurance allowance for sedation. I just can’t get through a dental appointment without it. If this is an issue my dentist is responsible for, shouldn’t she cover fixing the partial and waive the fee for sedation? – Patrick T.


Although partial dentures are made at a dental lab, most general dentists are able to loosen a clasp on the denture. Partial dentures are usually uncomfortable when you first receive them. The tight clasp might not necessarily be your dentist’s fault. Ask her to explain the reason for the discomfort.

Call your dentist to let her know your concern. If you’ve had the partial denture for longer than a month, she will want to promptly check it. A clasp that is too tight on a tooth for a long period can potentially damage the tooth.

Ask Your Dentist about Sedation

You should speak with your dentist about your need for sedation and ask if she is willing to waive the fee. You can also contact your insurance company, explain the circumstances, and ask for special consideration for any insurance claim that will be submitted for sedation fees.

Options for Replacing Missing Teeth

Dental implants are an option for permanently replacing teeth without the adjustment period or the discomfort of partial dentures.  But dental implants are a more expensive option, and your dentist must determine if you are a candidate for them. They have several advantages over a partial denture:

  • Surgically implanted in your jawbone
  • Stimulate bone growth and prevent shrinkage
  • Look and feel like your natural teeth
  • Don’t need to be secured to an adjacent tooth
  • More cost-effective in the long-term because they are permanent

If your budget permits, you can consider dental implants as an alternative in the future when you need a new partial denture.

We hope you have a successful outcome with adjusting your partial denture and getting assistance with the cost of sedation dentistry.

This blog is sponsored by Plano sedation dentist Dr. Miranda Lacy.

Will sedation dentistry legislation require insurance companies to provide more benefits?

My sister lives in California and has been raving because she says there’s a law there requiring insurance companies to cover sedation dentistry. She and I both had terrible experiences as children and don’t do well for any kind of dental procedure unless we have some kind of medication to get us through. This is big news because we’ve always had to pay out-of-pocket for it, and we don’t have the best teeth. I’ve looked and looked, but I don’t see anything that discusses this law- either as something in place or upcoming. Any news?

Thanks, Emilia

Dear Emilia,

Head and shoulders photo of a man and woman lying in a field of flowers, for information on sedation dentistry from Plano TX dentist Dr. Miranda Lacy.California has some incredibly progressive laws in many respects. Many regulations originate in California before they are adopted in other states. California Assembly Bill 2643 amends Section 1367.1 of the Health and Safety Code and Section 10119.9. SB 2643. It outlines a number of regulations that have to do with “the use of general anesthesia, conscious sedation, and oral conscious sedation (OCS) for pediatric and adult patients.”

  • The current language of the laws stipulates that dental anesthesia only has mandatory coverage in a hospital setting. As you probably know, there are many people who genuinely require anesthesia, but don’t need to go to a hospital for treatment.
  • The proposed legislation would force new insurance plans to cover it effective January 2019.
  • The proposed law is being sponsored by the California Dental Association and California Society of Pediatric Dentistry. It is not yet approved. If passed, it could make a major difference for people like your sister who lives in California.

Sedation Dentistry and Insurance

Throughout the rest of the country, coverage for any form of anesthesia or OCS varies based on the insurance policy. While most insurance companies recognize that OCS makes it possible for many people to receive treatment,  manage their oral health better, and possibly reduce expenses for insurance companies overall,  most insurance companies are reluctant to add sedation dentistry as a necessary and valuable benefit.

It sounds as if you’ve personally made your oral health a priority and have found a way to budget for it, which is commendable. Patients who are still trying to find a way to manage dental anxiety and get necessary treatment may be able to find a plan that specifically covers OCS. It is worth noting that very few offer coverage and when they do, it can be costly.

As an alternative, it’s helpful to speak with your dentist about what your anxiety and finding affordable dental treatment. Most dentists will work with you to overcome the issues, perhaps by doing as much work as possible in a single appointment or doing the work in phases. Your dentist may have additional solutions.

This blog is sponsored by Plano sedation dentist, Dr. Miranda Lacy.

Will insurance cover sedation dentistry?

I need 3 fillings replaced. I’ve had the fillings since I was 15 years old. 2 weeks ago one of them cracked. It broke a piece of the tooth off so bad that I had to go to an emergency dentist. He said I now need a crown. I am dreading this work that needs to be done. The dentist saw my anxiety level increases as he was explaining everything that needs to be done. He said that a sedation  dentist might help me relax and if I wanted to I could go to another dentist who offers it. I’ve haven’t been to a dentist for about 5 months because my old dentist left his practice. Now the thought of being sedated by a new dentist and having this be the first major work done for me is making me more nervous. Is this something that insurance covers?

Whether or not insurance provides benefits for sedation dentistry depends on your individual plan and the type of sedation offered. Some procedures are billed to dental insurance, and others are billed to dental insurance. In advance of your procedure, the dental office can contact your insurance companies to determine if any benefits are provided. Keep in mind that it is unlikely that insurance will cover the entire cost, but some benefits might be provided.

If sedation dentistry is used during an appointment with an oral surgeon, an anesthesiologist might be present to administer it. The insurance will likely provide some benefits for the sedation, which is often referred to as twilight.

Sedation at a dental office for general procedures is usually nitrous oxide or oral conscious sedation. Anti-anxiety medication is given for oral conscious sedation, and insurance generally doesn’t cover it.

You can search for experienced sedation dentists who use different levels of sedation, depending on your procedure and anxiety level. Ask about each dentist’s training, credentials, and experience. Schedule a consultation with two or three sedation dentists and get a feel for how you are treated as a patient. If you are comfortable with the dentist and his or her office environment, it might be easier to trust the dentist with giving you medication to help you relax.

Remember that you will still be conscious during your appointment and able to respond to the dentist’s questions, and to let the dentist know if you are experiencing any discomfort. Your vital signs are monitored throughout the procedure.

Ensure you are comfortable and have enough information about sedation dentistry and your dental procedures before you schedule an appointment to have your dental work completed. It help your appointment to go smoothly.

This post is sponsored by Plano, TX female dentist Dr. Miranda Lacy.