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Are Deep Cleanings Covered By Dental Insurance? Yes! In Most Cases! But The Antibiotic Rinse Is Not!

Updated on October 29, 2010

If it is Covered at 100%, Why am I Being Charged?

For those of you who have dental insurance and require what is known as a deep cleaning, ask your insurance company if this procedure is covered. It has been my experience that most dental insurance companies consider this to be a benefit. Many cover deep cleanings twice a year at 100%. But prior to getting a deep cleaning, understand that the antibiotic rinse that is recommended by most dentists' offices is NOT covered. That can make a relatively inexpensive or even free procedure quite costly. The rinse is charged for by the quadrant. The charge is typically $70.00 to $80.00 per quadrant. This will then total $280.00 to $320.00 for a service that is covered by your dental policy. If a dental clinic or dental office tells you that you require a deep cleaning more than the insurance company standard of 2 X per year, find a different dentist or get a second opinion.

I recently went for dental work and I know my dental insurance policy thoroughly. I know what is covered before I have something done and what my out of pocket cost should be. When scheduling a deep cleaning, I was told that the cost would be $280.00. I told the dental hygenist that my cost should be zero. She proceeded to tell me that I needed to have an antibiotic rinse during the cleaning. This medication would go down into the bone and kill any infection that there might be and that it is necessary, but that my insurance company would not cover the antibiotic rinse, so I would have to pay for it. I told her that I am on a budget and that if the insurance company would not pay for it then I would opt for the cleaning without the antibiotic rinse. She continued to tell me the benefits of the rinse and I continued to tell her that I didn't want it. Finally, we made the decision that the deep cleaning would be done without the rinse.

Everyone Has to Make a Living

The insurance company does not cover the antibiotic rinse for one reason. Its effectiveness has not been proven. Plain and simple. There is no evidence that conclusively proves that the use of an antibiotic rinse works. Quite simply then, if the insurance company will not pay for this because they believe it to be unnecessary, then I can't be paying for it either.  

I understand that the dentist needs to make a living and he or she may sincerely believe that this will help most patients, but I have to be aware of the limits of my own budget.

This is just one procedure that you can save money on by thinking about your options. You may decide that you want an antibiotic rinse and that is fine. My purpose here is to make sure you are informed and to let you know that you have a choice.  I will be touching on other ways to help you save money and get the most out of your dental insurance policy in future hubs.

What Is A Deep Cleaning of the Teeth?

Deep cleaning is a method of teeth cleaning used to control or prevent periodontal disease or gum disease. It is also called root planning or root scaling. It combines cleaning above the gum line as well as scraping tartar below the gum line. As stated before, it is almost always covered by insurance.

If you have ever been in the dentist's office, you may remember the dentist looking at each of your teeth and as he does, he recites the tooth number and after that, something else. He will say 3, 4, 5, etc. That is his way of charting bone loss and evidence of how deep the periodontal pockets are. If you hear a lot of 4's or 5's, that is not a good thing! Anything higher than a 3 and chances are you have gum disease. While gum disease cannot be cured once you have it, it can in most instances, be controlled by deep cleanings.

Deep cleanings, sad to say, are many times necessary! They can be uncomfortable, depending on the extent of the disease. If the cleaning is too uncomfortable, it can be done in more than one session, even one quadrant at a time.

If it is painful, ask the hygenist to put more gel on the area. Sometimes that will help dull the pain. They should not be charging any more money for more gel. That is included in the procedure.

Diabetics, or anyone with a chronic disease, are likely to develop gum disease. It comes with the territory. Check with your physician prior to having a deep cleaning. Some patients require pre-treatment with an antibiotic. No  matter how many times the dentist tells you it is not necessary, listen to the advice of your medical doctor! They are more equipped to advise you medically.

Comments

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  • tmbridgeland profile image

    tmbridgeland 

    7 years ago from Small Town, Illinois

    I don't know about other insurance companies, but in our customer service we are required to answer a call-in within two minutes. Last week our average time to answer was 11 seconds. People, call your insurance company! Ask your dentist's office to call us if you don't understand your policy. Most dentists are happy to do that, they don't like it when insurance doesn't pay, either.

  • Jillian Barclay profile imageAUTHOR

    Donna Lichtenfels 

    7 years ago from California, USA

    Thank you, tmbridgeland. People have to read their policies and dentists should be obligated to explain the treatments they plan to provide. Part of the problem may be that many patients don't even realize a standard cleaning is far different from a deep cleaning.

    I always ask what procedure codes are going to be billed, and if I have any doubts, I call my insurance company...

  • tmbridgeland profile image

    tmbridgeland 

    7 years ago from Small Town, Illinois

    Hi Jillian. I work in dental insurance, and have to say I agree with most of this info. But, a lot of policies only cover the routine cleaning, and don't cover the deep cleaning. Or, the deep cleaning is covered at a lower percent, so the patients end up paying a lot for them. Dentists often don't tell the patient what kind of cleaning they will do, so patients are shocked when they get the insurance payment, it is a lot less than they expected, and they have to pay a lot for what they thought was free. Good Hub with good info.

  • Jillian Barclay profile imageAUTHOR

    Donna Lichtenfels 

    8 years ago from California, USA

    You are right! I get most uncomfortable when I am sitting in a waiting room and I keep hearing the words, "Scheudle Mrs. So and So for a root canal" and then every two minutes thereafter, I here the same words repeated again just with a different patient. Over and over and over. Makes you wonder why that has to be the world we live in?

  • profile image

    Milzter 

    8 years ago

    Every dentist you have ever known seems to be making money right? Well then you know why there are hidden costs? Read the small print, and ask questions before you have any work done, and yes your chances of still being billed for something is high...it's the world we live in :

  • Jillian Barclay profile imageAUTHOR

    Donna Lichtenfels 

    8 years ago from California, USA

    Thanks, Deni! When the dentist told me what my cost would be, he also did not offer that it was for the rinse. Just matter of factly stated, "This procedure will be $280.00". Thank goodness I knew my policy and you obviously know yours. We have to protect our money;it is not like we all have tons of money laying around. Thank you for your comment. I appreciate it!

  • Deni Edwards profile image

    Jenifer L 

    8 years ago from california

    I had this same experience. I was told that insurance only covered part of the procedure and that I would have to pay for the rest. Turns out, they were attempting to charge me for the rinse (without telling me it was the rinse). Of course, I opted not to get the rinse, and the cleaning cost me no money out of my pocket--if I had not known I would have ended up paying several hundred dollars under the deception that it wasn't covered.

    Great hub! Thanks for the information.

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