What insurance covers root canals

As we get older, tooth damage can develop over time. Regularly visiting a dentist and committing to a thorough oral health care routine can help

prevent damage, but it is easy to ignore small problems, especially with a busy schedule. When tooth damage is left for a significant period, it can develop into decay and require a root canal in order to be fixed. We’re going to discuss what this common procedure entails and how to determine if it is covered by your dental insurance plan.

Índice Show

What is a root canal?
Are root canals covered by dental benefits?
What’s a root canal?
Symptoms can include:
When you get a root canal, here’s what happens…
Root canal cost + dental insurance
4 benefits of a root canal
Need a root canal? Dental insurance with no waiting period may be a smart move.

What is a root canal?

The inside of a tooth can become inflamed or infected for a variety of reasons and a root canal may be required for repair. A root canal is a procedure used to save a tooth that might otherwise have to be removed. During this routine procedure, the damaged pulp inside of a tooth is removed. Then, the inside of the tooth is cleaned and disinfected before being refilled with a restorative substance. Normally, pulp is protected by tooth enamel and infection develops when that enamel is lost, chipped or damaged. In order to prevent the cleaned tooth from getting re-infected, it will be sealed for protection. A root canal treatment can be very effective if successful, allowing you to bite and chew normally.

A root canal procedure can be daunting for patients, but it is actually a very common procedure that is routine in most dental clinics. Current root canal procedures are stress and pain free, allowing you to repair damaged teeth comfortably and efficiently. Moderate sedation is available for most procedures and post-operative care is easily accessible to ensure a smooth recovery.

Are root canals covered by dental benefits?

Many insurance companies offer comprehensive dental coverage that includes regular check-ups, diagnosis, tests, cleanings and oral surgery procedures. Depending on your coverage, you will likely be able to claim most if not all the cost for a root canal. In order to determine if your root canal will be covered, contact your insurance provider before the surgery. This can help you and your dentist determine what will be covered and how that will fit into your regular dental check-ups and cleanings for the year.

The best way to avoid tooth damage and decay is to ensure you are following a comprehensive dental care routine. This includes brushing and flossing twice daily and regularly visiting your dentist. If you are experiencing pain or discomfort, you may have an infection or decay that will require a root canal. If you are looking for a dentist in the Vaughan, Maple or Woodbridge area, look no further than Dr. Lloyd Pedvis at Mackenzie Dental Centre. An experienced cosmetic and family dentist, Dr. Pedvis leads his experienced team through regular check-ups and more complicated procedures. For a stress and pain-free root canal, Mackenzie Dental Centre can help provide you with exceptional care. For more information or to book an appointment, contact us today at 905-417-8700.

Need a root canal? Dental insurance with no waiting period may help lower your out-of-pocket cost to get your tooth fixed faster.

It’s true. You can apply for dental insurance with no waiting period for preventive services and basic care like cleanings, exams, and fillings. But if you need a root canal, many dental insurance plans require a waiting period of 6 to 12 months before it’s covered.

And that could be a pain in the mouth…and your pocket book.

What’s a root canal?

If you need a root canal (it’s also called endodontic treatment), chances are pretty good you’ve got a tooth that’s bothering you.

Symptoms can include:

Pain around the tooth when you chew or bite
A tooth that’s chipped or cracked
Irritated, inflamed or swollen gums
Sensitivity to hot and cold food and drink
Dark-colored gums or excessive tooth decay

If your dentist says, “you need a root canal,” you have a diseased or damaged tooth caused by bacteria.

When you get a root canal, here’s what happens…

Your dentist will examine your teeth and gums for decay, bacteria, and other signs you may need a root canal.
If the results are positive, your dentist will prep you for a root canal by numbing the area around the damaged tooth.
Next, the infected pulp or dentin inside your tooth will be removed.
Then the inside of your tooth will be cleaned, followed by a filling and sealing.
Within a couple of hours, the numbness will be gone and so will your tooth pain.

Root canal cost + dental insurance

How much does a root canal cost? It depends.

Root canal with insurance: If you have an existing dental insurance policy, your plan may cover 30 to 50% or more of the cost to get a root canal.2
Root canal without insurance. If you don’t have dental insurance, it could be expensive. The average cost of a root canal without dental insurance is $700 to $1,200.2

4 benefits of a root canal

If you need a root canal, but don’t do anything about it, it could impact your quality of life and your health. Fortunately, a root canal is a relatively simple procedure that can fix a damaged tooth and help you:

Chew your food.
Improve your smile.
Improve biting power.
Protect other teeth from damage, decay, and bacteria.

Need a root canal? Dental insurance with no waiting period may be a smart move.

Think about it this way. If you purchase dental insurance with waiting periods and get a major dental service prior to the end of the waiting period, you may be responsible for 100% of the bill. Plans with no waiting periods can activate quickly, which may decrease your out-of-pocket expenses sooner than a plan with a waiting period. If you need a root canal or any other type of dental care, now is always a good time to apply for dental insurance.

Ready to find a dental plan that works for you? Find a plan online, or call (800) 360-1402 to talk with a licensed insurance agent.

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References:
1. What is a root canal? Retrieved from: https://www.aae.org/patients/root-canal-treatment/what-is-a-root-canal/ Accessed on May 19, 2022. | 2. Cost of a root canal without insurance and with insurance. Retrieved from: https://www.newmouth.com/blog/root-canal-without-insurance/ Accessed on May 19, 2022.

Many insurance companies cover root canal treatment, though whether they cover the treatment depends on:

Why the treatment is needed
Who is performing the procedure

How much an insurance company pays toward endodontic treatment depends on multiple factors, all of which are (or should be) outlined in the written policy provided by the insurance company.

Terms You Need to Know

The following are a few of the factors that will impact how much a dental insurance company will contribute toward root canal therapy.

Deductible: Every year, patients will need to pay a deductible before the insurance company pays any part of their dental treatment costs. Deductibles can range from $100 to over $2,000 depending on the insurance company, coverage, and whether the patient has an individual or family plan. Once the deductible has been met, the insurance company will start to pay its portion of dental costs.
Co-pay: Most insurance companies only cover a percentage of treatment costs. Many (but not all) pay 100 percent toward diagnostic and preventative procedures (up to the annual maximum). For restorative procedures (fillings), coverage is often around 80%, meaning the patient must pay for 20% of the procedure. Major procedures (crowns, dentures) are often covered at 50%. It is important to note that not all insurance plans stick to this percentage breakdown. If they choose to pay less, the patient is responsible for the difference. Root canals are typically covered at 50% to 80%.
Coverage terms: Some policies do not cover root canals. Instead, they only cover diagnostic and preventative procedures (cleanings, exams). It is important for patients to carefully read through insurance documentation and review the coverage terms, so they are not surprised when it is time to pay their dental bill.
Dual insurance coverage: Some patients are fortunate enough to have dual insurance coverage. In this instance, the primary insurance company will pay their percentage and the supplementary insurance company will pay the balance or a percentage of the balance. Patients should discuss their policies with their insurance company and their endodontic team to determine what, if any, co-pay amount they will be responsible for paying.
Waiting period: A few insurance companies will start paying for diagnostic, preventative, and even basic restorative procedures as soon as a policy is activated. However, when it comes to major dental procedures, they may have a waiting period of six to 12 months. During this period, the patient is 100% responsible for the cost of any major restorative treatments.
Maximums: In addition to coverage percentages and deductibles, patients also need to be aware of another number: their annual maximum. Depending on the company and policy, maximums can range from $500 to $2,500. Once an insurance company has covered their percentage of costs up to the maximum amount, the patient is then fully responsible for any remaining treatment costs.
Preauthorization/Prior Authorization: Before considering payment, some insurance companies require a preauthorization. This form is like a typical claim form except that it is sent before the procedure is performed. Based on the insurance company’s response to the preauthorization claim, the endodontist can provide the patient with an even better idea of how much of their dental bill they will need to pay.
Claim denial: Insurance companies reserve the right to deny claims based on certain factors. These can range from a procedure being done before the waiting period ended, the procedure performed not being a covered benefit (a night guard for TMJ, for example), or the company viewing the procedure as elective and not a dental necessity (for instance, veneers for aesthetic purposes). In some cases, your endodontist can fight a claim denial by resubmitting a claim with more details, including diagnostics, chart notes, and information provided by a dentist’s second opinion.

Does Your Endodontic Provider Accept Your Insurance?

Another factor to consider is whether your endodontic provider accepts your insurance. You may have the lowest deductible, highest maximum, and best percentage of coverage for procedures, but if your provider does not work with that insurance company, you will still be responsible for the majority (or all) of costs.

Dental providers are not required by law to work with all insurance providers.

Renovo accepts PPO plans and most HMO plans. Our team will work with you and your insurance company to provide you with the best treatment, an as-accurate-as-possible treatment plan estimate, and affordable costs.

Other Payment and Coverage Options

Root canal therapy is one of the best treatment options for preventing tooth loss. And oftentimes, it is done on an emergency basis due to trauma or infection.

We understand how stressful unexpected costs can be and want to help alleviate as much stress as possible. That is why we offer an outside financing option to help patients who do not have insurance or who need assistance paying their copayments and deductibles. Talk to our team to learn more!

Renovo Endodontic Studio: Giving You All the Information You Need

For most people, the decision-making process is not an easy one. We want to help, which is why our team of diverse endodontists and compassionate assistants will go the extra mile when it comes to determining your treatment costs.

When you visit one of our offices, our team will take the time to contact your insurance to verify your benefits/coverage and provide you with the most accurate co-payment estimate possible. Our team will also discuss payment options and outside financing.

We understand that dental care is not a cheap investment. However, we know that when you invest with Renovo, you receive the highest-quality endodontic care, which can provide you with pain relief and peace of mind.

Do you still have questions about endodontic costs? Contact our team. We’re happy to address your concerns right away.