How Can You Fight For Root Canal Coverage?

If you've been suffering intermittent pain in your tooth while chewing or eating especially hot or cold foods, you may suspect you need a root canal in order to save your tooth. However, you could be dismayed upon finding out that your dental insurance will pay only for an extraction of the affected tooth, rather than a root canal. You may be reluctant to pay additional costs to have a root canal performed when an extraction will end your dental pain just as effectively -- however, in some situations, an extraction could cause you trouble down the road. Read on to learn more about why coverage is sometimes denied for root canals, as well as what you can do to fight for root canal coverage or otherwise reduce your out-of-pocket costs. 

Why are there differences between the coverage for an extraction and for a root canal?

In most cases, it's not that an extraction is covered more than a root canal -- it's that the root canal is more expensive. The average extraction costs between $75 and $300 (most of which should be covered by your insurance plan), while a root canal and crown can total anywhere from $1300 to $2300, depending upon the cost of living in your area and the size and condition of the tooth being treated. The annual dollar maximum of your dental insurance coverage may be reached before your root canal and crown are fully paid off , leaving the remaining cost for you to pay out-of-pocket. 

Is it important to have a root canal performed?

With these differences in cost, it can be tempting to go the extraction route to avoid paying an extra $1000 or more for a root canal. However, in many cases, an extraction may cause you problems in the future.  Your teeth may spread to fill in the area where your missing tooth was once located, and you may suffer damage to the surrounding teeth due to the change in your bite. If it's at all possible to save your tooth with a root canal rather than remove it permanently with an extraction, doing so is generally the best long-term decision.

How can you avoid paying high out-of-pocket costs for a root canal?

In some cases, your bill may be due to your insurance company's denial of coverage for this procedure. If the procedure (particularly the crown) isn't deemed medically necessary but simply cosmetic, it's likely it wasn't selected for coverage. Having the procedure correctly re-coded as medically necessary may help increase the amount of coverage provided or even eliminate out-of-pocket costs.

If your annual insurance maximum has been reached, you could qualify for a dental credit plan or another type of credit that will help you make these payments without incurring significant financial hardship. Your dentist may even give you a discount for financing your root canal through a program offered by his or her office.