Navigating dental insurance can feel like trying to read a map in a different language—especially when it comes to “specialist” care. The good news is that because gum disease is a medical infection of the bone and tissue, most insurance plans do provide coverage for its treatment.
At Chula Vista Periodontics, we are the most sought-after office in the South Bay not just for our clinical results, but for our expertise in helping patients maximize their benefits. We believe that your financial health is just as important as your oral health.
Does Insurance Cover Gum Disease Treatment?
Yes, the vast majority of PPO dental insurance plans cover gum disease treatment. However, insurance companies categorize periodontal care differently than they do a standard filling or cleaning.
1. Basic vs. Major Coverage
Insurance companies typically divide treatments into three buckets. Periodontal care usually sits in the middle:
Preventative (100% covered): This includes your biannual checkups. Note that once you have gum disease, a “regular cleaning” is no longer enough.
Basic Procedures (50% – 80% covered): Most plans classify Laser Scaling and Root Planing (deep cleaning) as a basic procedure.
Major Procedures (25% – 50% covered): Surgical treatments, such as LANAP® laser surgery or gum grafting, are often categorized as major.
2. The “Four Quadrant” Rule
Most insurance plans pay for scaling and root planing by the “quadrant” (the four sections of your mouth). It is common for plans to have a frequency limitation, such as only paying for a deep cleaning once every 24 months. This is why it is vital to have a specialist like Dr. Susan Nguyen perform the treatment correctly the first time.
3. Periodontal Maintenance
After your initial treatment, you will need periodontal maintenance. Many insurance plans will cover two of these per year, but since most periodontal patients need four cleanings a year to prevent bone loss, we work with you to find the most cost-effective schedule.
Maximizing Your Benefits at Chula Vista Periodontics
As a specialist office, we handle the complex paperwork that general dentists might find overwhelming. We go the extra mile to ensure you get the coverage you deserve:
Pre-Authorizations: For advanced treatments like LANAP®, we send digital X-rays and periodontal charting to your insurance company before you start, so you know your exact out-of-pocket cost.
Medicare Advantage (Part C): Many of our senior patients are surprised to learn that certain Medicare Advantage plans may help cover periodontal care or dental implants.
Flexible Financing: If your insurance has a low annual maximum (usually between $1,500 and $2,500), we offer low-monthly-payment plans through CareCredit to bridge the gap. You can explore our financing options here.
Why Waiting is More Expensive
If you delay gum disease treatment because of insurance concerns, you risk the infection reaching the advanced stages of periodontitis. The cost of a deep cleaning is a fraction of the cost of permanent dental implants required after tooth loss.
Let Us Check Your Coverage For You
Don’t guess what your insurance covers. Our expert administrative team will perform a complimentary insurance verification as part of your initial consultation. We are here to make the most sought-after care in Chula Vista accessible to you.
Schedule Your Consultation and Benefits Check Today or call us at (619) 425-9770.
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