Why Is Dental Insurance Verification Important For Root Canal Treatment?

by | Last updated Dec 15, 2023 | Published on Nov 26, 2021 | Dental Insurance Verification

Dental Insurance Verification
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Root canal treatment, also known as endodontic therapy, is required when infection or inflammation develops in the pulp or the soft tissue inside the root canal. The procedure removes infection from the inner layer of a tooth. It can also prevent reinfection and save the natural tooth. The cost of a root canal depends on the position and condition of the afflicted tooth. Many insurance companies provide comprehensive dental coverage that includes regular check-ups, diagnosis, tests, cleanings and oral surgery procedures. Dental insurance is available for root canals, though the extent of coverage would depend on the patient’s plan. Dental insurance verification important for practitioners to determine the patient’s eligibility for coverage of root canal treatment. Insurance verification also helps communicate patient responsibility clearly to the patient before they receive the treatment.

Factors affecting Cost of Root Canal Treatment

Root canal therapy costs depend on many factors, but costs less than getting a crown or bridge to replace an extracted tooth. The most common root canal (endodontic) procedures are:

  • Root Canal – Front Tooth
  • Root Canal – Premolar
  • Root Canal – Molar

Many factors impact root canal treatment cost:

  • The location of the infected tooth: A cavity on a front tooth will cost less to treat while molar teeth usually have more canals are difficult to address and cost more.
  • Geographic location: root canal costs are likely be higher in big cities compared to small towns.
  • Complexity of the problem – how severe the cavity is and what needs to be done to repair the infected tooth. A severe infection might need more intense treatment such as a crown whereas a small cavity would just need a filling.
  • Retreatment: If the infection is in a tooth that already had a root canal, more extensive treatment will be needed
  • Costs of initial consultations, X-rays, anesthesia, emergency fees, etc

With comprehensive dental insurance, patients may be able to claim most, if not all, root canal therapy costs. Dental insurance verification is important for practices to understand patients’ eligibility for root canal treatment.

Root Canal Treatment: Why Insurance Verification is Important

There are many reasons why dental eligibility verification is crucial for root canal therapy:

  • Dental insurance plans usually cover 50% to 80% of the cost of root canal therapy after the deductible has been met.
  • Coverage will depend on whether the patient’s dentist or endodontist is in-network or out-of-network.
  • Dental eligibility verification should be done before services are provided. Smooth and accurate eligibility verification minimizes billing errors.
  • Not doing verifying coverage could result in unpaid claims or delayed reimbursement for the practice or unexpected bills for the patient.

Insurance companies may also require preauthorization for root canal treatment. Horizon NJ Health announced a new prior-authorization process for dental plans effective March 1, 2021. This includes updates for root canals. The information as provided on their website is as follows:

On Authorization for Root Canals, Post/cores, Build-ups and Crowns, the announcement states:

  • Currently, prior-authorization (PA) is required for root canal, post/core and crown procedures.
  • There will be a new authorization process for root canal, post/core and crown procedures.
    • A retro-authorization will be required when services are completed.

The announcement also lists the clinical criteria and documentation requirements for the above.

On Radiographs and Root Canals, Retreatment, the announcement states:

  • All X-rays taken for root canals and retreatment of root canals will be considered as inherent to the procedure and not paid on the same date of service as D3310, D3320, D3330, D3331, D3346, D3347 and D3348.

Dental Insurance Eligibility Verification Process

Dental insurance may cover root canals as basic procedures or with less coverage for major procedures. The best way for practices to ease the patient intake process is to rely on an experienced dental insurance verification to understand patients’ coverage before the office visit. The process involves verifying the following

  • Effective coverage dates
  • Waiting periods
  • Maximums and deductibles
  • Treatment history
  • Benefits used to date
  • Type of plan and fee schedule
  • Verify claim submission information (address, phone number, payor ID etc.)
  • Coverage percentage by category
  • Implant and Orthodontic coverages
  • Frequencies, limitations, and exclusions
  • Missing tooth clause
  • Specific codes as required

Reliable insurance eligibility verification services will help patients avoid surprise out-of-pocket payments, claim submission delays, or errors, improve patient care. By reducing administrative burdens, dental insurance verification companies allow dentists and their staff to focus on providing high-quality patient-centered care and improving the practice’s revenue cycle.

Amber Darst

Amber Darst is our Solutions Manager in the Healthcare Division, Practice and RCM. With a rich background in dental services, her expertise ranges from insurance coordination to office management.

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