Covered And Non-Covered Dental Services In The Emergency Room
Posted on March 16, 2011
Q: Are dental services in the Emergency Room covered under my HNE plan?
A: The coverage for dental services under most HNE plans is limited. The only services that are covered are:
Services resulting from a traumatic injury to sound, natural teeth.
Here is an example. While playing catch with a softball, you are hit in the mouth. The injury loosens one of your own teeth (not dentures or implants) and you need stitches in your lip. HNE covers the sutures to repair your injury and services to stabilize your loose tooth. These services are covered in the emergency room (ER), urgent care setting, or dentist’s office. All services, except for suture removal, must be received within 72 hours of the injury. Any follow up dental services for the injury, such as restorative services, are not covered.
In addition, any dental services provided in any setting (ER, Urgent Care, or in the office) other than those described above are not covered. Please refer to your Member Materials for specific coverage guidelines.
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