The field of dentistry has undergone many changes since the last century. New specialties have been introduced, along with novel ways to look at oral health. Biological dentistry, truly holistic in its thinking, not only looks at your teeth but your general health. However, the more that patients look into these alternative methods of dental care, the more frequent one question arises: are biological dentists covered by insurance​ ?
This guide is for you if you want to learn everything behind biological dentistry and determine whether any form of dental insurance can help supplement the expenses. We will also assess reasons why insurance companies sometimes would rather not cover their services, pricing without coverage, and options in making biological dentistry more affordable for you.
What Is Biological Dentistry?
Certain insurance policies may offer coverage, depending on state law and policy regulations. It’s essential to understand the practice of biological dentistry before we answer.
Biological dentistry, often called holistic dentistry or integrative dentistry, is a method of therapy with a special emphasis on the relationship of oral health with general health. While conventional dentistry largely treats diseases of the mouth, biological dentistry considers the ways in which dental treatment of a particular patient may affect his or her general health.
Principles of Biological Dentistry
- Biocompatible Materials – Biological dentists use materials considered harmless to the body, rejecting metals or chemicals that have adverse reactions.
- Mercury-Free Fillings – Many would reject amalgam fillings that contain mercury, intending to use resin or ceramic ones instead.
- Prevention-Oriented – Prevention of dental problems, with a lifestyle conducive to lessening dental and systemic health issues, is encouraged.
- Minimally Invasive Treatments – Treatments aim to conserve as much of the natural tooth structure as possible.
- Holistic Approach – Oral health problems are assessed from the viewpoint of whole-body health, nutrition, immune function, and system
Examples of Services Provided
- Mercury filling removal (according to safe removal protocols)
- Use of non-toxic, BPA-free dental materials
- Advanced periodontal care to reduce inflammation
- Ozone therapy to treat gum and tooth infections
- Nutritional counseling for oral-health issues
Since this method combines alternative and sometimes unusual techniques, many patients wonder-are biological dentists covered by insurance​ ?The answer is complicated in nature.
Are Biological Dentists Covered by Insurance?
Here goes a very short explanation: In some cases, insurance pays; in others, insurance does not provide coverage. Because dental insurance pays only for procedures one must have done, in keeping with conventional standards of care, the services carried out by a biological dentist are in fact the same as those practiced by your standard dentist. The difference lies in how each performs a procedure and with which materials.
If the dental procedure you are having performed is what is considered a standard dental service, such as:
- X-rays
- Regular check-ups
- Fillings
- Root canals
- Tooth extractions
The good news is that your dental insurance has a good chance of covering it, whether the dentist performing them is biological or traditional.
If, however, an alternative method is used, like ozone therapy, heavy metal detoxification, or holistic nutrition counseling, the insurance companies may very well consider these procedures to be non-essential or experimental, and as a result, will deny coverage for them.
Factors That Affect Coverage
Consider the Type of Insurance Plan
- Some PPO plans may reimburse you for services rendered by an out-of-network general biological dentist.
- Some HMO plans will require the selection of a dentist within the network-this network might not include biological dentists.
Classification of Procedures
- If a biological dentist performs filling procedures using resin that are classified as resin fillings and not amalgam for insurance purposes, then maybe it will be covered.
- If it is against conventional dentistry to recommend a treatment, then insurance coverage may be denied.
In-Network vs. Out-Network
- In the case of biological dentists that are in-network, coverage is more probable.
- Out-of-network biological dentists may require you to pay in full and seek partial reimbursement.
State Regulations
- Certain states have stricter insurance regulations, which possibly assist in covering more holistic forms of treatment.
Why Insurance Sometimes Won’t Cover Biological Dentistry
If z highbrow biological dentists are rarely accepted and covered by insurance, it is because insurance companies determine coverages based on what is considered “standard care” within the dental industry.
Some Common Reasons for Denial
Labeling as Alternative or Experimental
Ozone therapy, laser detoxification, and some natural health material replacements may indeed not be recognized as standard procedures.
Preventive vs. Restorative
Generally, insurance covers restorative care more than preventive or elective holistic care.
Billing Codes
Insurance claims are processed through standardized dental procedure codes. If dental services do not match any of these codes or are fraudulent in nature, then the policy will indeed reject the claim.
Non-Standard Materials
If the dentist selects a costlier biocompatible material in preference over a standard material covered by insurance, you may have to pay the difference or the full amount.
A Realistic Scenario
If a patient requires a crown and the biological dentist says zirconia instead of porcelain-fused-to-metal (PFM), the insurance may firmly reimburse only up to the PFM rate; then you will love footing the bill for the difference.
The Cost of Seeing a Biological Dentist Without Insurance
Basic Estimate of Fees
- Initial Consultation: $150-$300
- Routine Cleaning: $100-$250
- Composite Fillings: $150-$300/tooth
- Zirconia Crowns: $1,000-$2,500 per crown
- Safe Mercury Removal: $300-$600/tooth
- Ozone Therapy: $75-$150 per session
- Nutritional Counseling: $75-$200 per visit
Pricing varies due to the following:
- Location: Urban clinics usually cost more.
- Dentist’s Expertise: Specialized biological dentists might charge higher rates.
- Materials Used: Higher quality, non-toxic materials usually cost more.
More Ways to Save
- Ask for In-Network Reimbursement
- If your dentist is not in-network, your PPO plan might pay for a certain percentage of the usual costs for the procedure.
Request for Alternative Treatment Codes
In some cases, services might be coded conventionally and have a higher chance of being approved.
Flexible Spending Account (FSA) or Health Savings Account (HSA)
Use your pre-tax dollars to pay for eligible dental expenses.
Payment plans
Allowing in-house financing and possibly third-party credit provide many biological dentists with options, such as CareCredit.
Membership plans
Certain clinics enable their clients to purchase annual memberships that entail the benefits of check-ups, cleanings, and discounts.
Conclusion
Are biological dentists covered by insurance? Sometimes, yes; sometimes, no. It depends on the treatment performed, the insurance plan and whether the dentist is in-network or not.
Usually procedures like cleanings, fillings, and crowns will have coverage, but holistic and alternative procedures might not. This is why insurance companies and your dentist must be contacted in advance if insurance coverage is to be considered.
If your phototherapy is not covered by your insurance, then there are options you will want to consider to potentially bring the cost of biological dental care within reach: reimbursement options, FSAs, HSAs, and payment plan options through your clinic. It all comes down to what you place higher priority on: your oral health and holistic well-being.
Frequently Asked Questions (FAQs)
1. Are biological dentists commonly covered by insurance plans?
Not necessarily. It depends on whether the treatment is considered by some to be standard care and if your plan includes that provider.
2. If I have a dental PPO, would I be able to afford the services of a biological dentist?
Virtually all PPO plans will let you see an out-of-network provider, and the disadvantage is that you usually pay more.
3. So why is it that some forms of biological dentistry are not covered?
An insurer may call these procedures: alternative, optional, or lacking scientific evidence sufficiently established.
4. How can I find out if biological dentistry is covered under my plan?
Call your insurer, give them treatment code numbers, and ask if the services are covered under your plan.
5. Should I pay for biological dentistry with my own money?
Patients usually answer that it is worth it for long-term health benefits, particularly if you have known sensitivities to traditional dental materials.
Confused about insurance coverage for biological dentists? Read our guide to know your options and make informed dental care decisions today! For any query, reach out to USInsurance247.
