Periodontal disease

Periodontal disease is a chronic bacterial infection that damages gums and bone supporting teeth. Dentists diagnose periodontal disease using clinical measurements like pocket depth greater than 3 mm or radiographic bone loss.

Dental insurance companies categorize periodontal treatment as either preventive (for scaling) or major (for surgery), examples include deep cleanings and osseous surgery. Standard dental plans like Delta Dental often cover periodontal maintenance at 80%, with annual maximums ranging from $1,000 to $2,000.

Major insurers require documented evidence such as probing charts and X-rays before authorizing coverage for procedures like flap surgery. Periodontal maintenance visits typically occur every three to four months, which plans like Cigna restrict to two or four times per year.

Waiting periods of six to twelve months frequently apply before full periodontal benefits activate under policies from providers including Guardian and MetLife. Out-of-pocket costs for nonsurgical treatments such as scaling average between $140 and $300 per quadrant in 2023.

Insurance often excludes experimental therapies, only covering FDA-approved treatments like scaling, root planing, and grafting, as reported by YourInsurance.info. Pre-existing conditions clauses can deny claims if records show untreated periodontitis before the policy’s effective date.

Failure to follow up on required periodontal re-evaluations may cause insurance denials for subsequent services according to Aetna’s clinical policy bulletins.