Yes, dental emergencies are typically covered under your plan benefits. The procedure type determines coverage level (basic for extractions, major for root canals, etc.).
Dental emergencies include severe toothache, knocked-out teeth, broken teeth with pain, dental abscesses, uncontrolled bleeding, and jaw injuries.
Dental insurance does not cover ER visits; medical insurance does. However, ERs provide limited dental care (pain relief, antibiotics) not definitive treatment.
Most PPO plans provide out-of-network emergency coverage, though at lower reimbursement rates. DHMO plans may only cover emergencies outside the service area.
Emergency treatment typically does not require pre-authorization. However, follow-up care may need approval. Contact your insurer after receiving emergency care.
Emergency costs vary by treatment: extractions 20-50% coinsurance, root canals 50% coinsurance. You pay applicable deductibles and coinsurance per your plan.
Insurance covers the dental procedure itself regardless of when performed. After-hours fees charged by dentists may not be covered as a separate benefit.
Call your insurance 24/7 helpline, search online provider directories filtered by emergency services, or call dentists directly to verify insurance acceptance.
If your plan covers extractions, emergency extractions are covered per your plan terms. Waiting periods for basic procedures may still apply to new coverage.
PPO plans cover out-of-network emergency care nationwide. DHMO plans may have limited or no coverage outside your local service area except for true emergencies.