Dental Coverage for Sedation Dentistry

In a dental clinic, patients may use sedation for a number of treatments from basic cleanings to invasive procedures. Reasons may vary but they often include fear of the dentist,  a low pain threshold, restlessness, a bad gag reflex, or a large amount of dental work needed at once. Dentists can offer different levels of sedation for patients, such as minimal sedation, moderate sedation, and deep sedation. Depending on the level needed, dentists provide different types of sedation, such as nitrous oxide with oxygen for inhaled minimal sedation and IV for moderate sedation. They could also provide general anesthesia, though it is usually not categorized as a sedation procedure. Dental insurance companies may or may not cover sedation in their policies.

Dental Coverage & Sedation

Patients may receive dental coverage for sedation procedures, depending on their policies’ terms and conditions. Many policies usually do not cover it because they classify sedation as a luxury, optional procedure. While some policies include benefits for mild sedatives, they usually do not include benefits for heavy doses of sedation. Beneficiaries who are over a specific age or disabled may be able to receive benefits for some sedation procedures. For people who require general anesthesia, their insurance may cover it as it is more likely to be a medically necessary part of the procedure. Patients could receive dental coverage for sedation needed for certain treatments, such as a filling or extraction.  Some policies may cover it if the patient has a medical condition or a disability that makes it impossible to receive proper dental care without being sedated.). Also, while most policies usually do not cover the cost of sedation to relax an anxious patient other policies could provide benefits to those with a medical diagnosis of a severe dental phobia.

Dental insurance policies may cover sedation, but it’s not a guarantee. People can also enroll in a more expensive policy that provides benefits for it or a plan that is tailored to it. It’s best to receive pre-approval from the insurance company before beginning sedation. If you are struggling with verifying coverage for sedation, consider partnering with eAssist. Our Success Consultants are familiar with the various coverages offered by insurance and will ensure your patient’s plans are verified correctly. To learn more, schedule a consultation here. 

Sandy Odle

Co-Founder and CXO, eAssist

Sandy Odle is the Co-Founder and CXO of eAssist Dental Solutions, where she has played a key role in shaping the company’s business and marketing strategies, leading to record growth and national recognition on the Inc. 500 and Utah Top 100 lists. A passionate social entrepreneur, Sandy believes that business is about building meaningful connections and creating personalized solutions that truly meet customer needs. Her relentless commitment to delivering exceptional client experiences is at the heart of eAssist’s mission. Drawing on the discipline and attention to detail honed during her early career as a ballet dancer, Sandy brings a unique blend of creativity, precision, and work ethic to everything she does.