Some insurances will pay for a dental emergency, however, some won’t. The majority of them will cover an emergency. It depends on the emergency and how the doctor writes up the patient notes for the insurance to review before paying. Most insurances like to have a detailed description of the procedure before it is done so that they know exactly what is being paid for. An x-ray completed insurance claim form, and dentist notes are required for any procedure that the insurance is going to be billed for. Then they make the decision on whether to pay or not. Some dental emergencies that would be covered are broken teeth, pain, trauma with dental complications, and post-care issues. All these things usually can’t wait and the patient has most likely waited until the last minute to call in for treatment thinking it will go away or it will be fine eventually.

In the event of a dental emergency, they may not pay until they get all the documentation they need. The patient may be billed in the meantime. Typically the dental office will allow a month or so to wait for the insurance to let them know if it is a covered procedure. The key to whether the insurance will pay is how the notes are written. Certain criteria must be in the notes such as if the procedure could have waited for normal business hours if it was after hours, if the procedure was already listed on a treatment plan, and if there is an x-ray that shows the reason for the emergency procedure.

If the patient is billed for the procedure and the office says it must be paid then the dental office will request that the payment go directly to the patient, not to them. They could apply it to the patient account however, it should be sent directly to the patient. Doing this will make sure that the patient gets reimbursed properly for a procedure that was most likely uncomfortable, to begin with, let alone having to pay for it out of their own pocket.