If you’re considering dental implants at Pacific Dental & Implant Solutions (PDIS) in Honolulu, understanding your Cigna Dental coverage is crucial for making informed decisions about your treatment. As an in-network provider with Cigna, PDIS works directly with your insurance to help maximize your benefits and minimize out-of-pocket expenses.
Cigna dental plans offer several options – including Dental Preventive, Dental 1000, Dental 1500, Dental 3000, and Dental 5000 plans – which provide different levels of coverage for dental procedures. However, it’s important to note that services considered strictly cosmetic in nature are typically excluded from coverage under most plans.
Disclaimer:
Pacific Dental & Implant Solutions is not an insurance provider, and all information provided regarding dental coverage is based on our experience working with these plans. Plan details, coverage limitations, and benefit structures can change at any time. While our Billing department is happy to work with you on maximizing your plan coverage and benefits, we encourage all patients to refer to their specific plan documentation or contact your dental insurance provider directly for the final determination regarding coverage. Insurance verification by our team is provided as a courtesy, but ultimate responsibility for understanding your benefits lies with you as the policyholder.
Cigna Dental Coverage Overview
As an in-network provider for Cigna dental insurance, our practice is committed to helping patients maximize their dental benefits and understand their coverage options. Our experienced team works directly with Cigna to ensure seamless billing and comprehensive care for our patients.
Want help understanding your exact coverage and benefits?
Schedule a free insurance verification with our team, and we’ll break down your specific Cigna Dental benefits before you begin treatment.
Network Status
Our practice is a fully credentialed Cigna participating provider, which means our patients enjoy significant advantages when using their Cigna dental insurance. By choosing our practice, patients benefit from:
- Streamlined claims processing
- Negotiated in-network rates
- Direct insurance verification
- Simplified out-of-pocket cost calculations
Our team can quickly verify your specific Cigna plan details and help you understand your coverage before any procedure, ensuring transparency and helping you make informed decisions about your dental care.
Coverage Limits
Cigna dental plans offer varying levels of coverage with annual maximums typically ranging from $1,000 to $5,000, depending on the specific plan chosen. Most plans feature:
- Preventive services typically covered at 100%
- Basic procedures often covered at 20-80%
- Major treatments usually covered at 50%
We recommend scheduling a pre-treatment consultation where our insurance specialists can provide a detailed breakdown of your expected coverage and potential out-of-pocket expenses.
Waiting Periods
Cigna dental plans may implement specific waiting periods, depending on your plan type:
- Preventive services are typically available immediately
- Basic procedures may have 6-month waiting periods
- Major treatments like crowns and bridges may require 12-month waiting periods
Our patient care coordinators can help you navigate these waiting periods and develop a strategic treatment plan that aligns with your insurance benefits and oral health needs.
What Cosmetic Dental Procedures Does Cigna Dental Insurance Cover?
Coverage varies by plan and typically requires procedures to be deemed medically necessary rather than purely cosmetic. Here’s a breakdown of common cosmetic procedures and their coverage under Cigna plans:
Dental Implants
Cigna dental plans generally provide limited coverage for dental implants. Coverage varies by specific plan type, with most plans excluding implant body placement and surgical procedures altogether. However, the restorative crown associated with an implant may be covered as an alternate service, subject to the plan’s frequency and service limitations.
The Cigna dental plans explicitly state that “The surgical placement of an implant body or framework of any type” is not covered. This includes:
- Surgical procedures in anticipation of implant placement
- Any device or surgical template guide used for implant surgery
- Treatment or repair of an existing implant
- Prefabricated or custom implant abutments
- Removal of an existing implant
Dental Crowns
Crown coverage through Cigna dental plans varies by plan type. Crowns are typically considered a major service covered at around 50% after deductibles. Coverage often requires crowns to be medically necessary rather than purely cosmetic. Most plans allow replacement of crowns only after a specified period (often 84 months) from initial placement.
Key restrictions include:
- Crowns must be necessary due to major decay or fracture
- Tooth cannot be restored with a filling
- Porcelain or white/tooth-colored materials may be limited on molar crowns
- For participants under 16, benefits are limited to resin or stainless steel crowns
Dental Bridges
Cigna dental plans provide bridge coverage as a major service, typically at the 50% coverage level after deductibles. Bridge replacements are usually available no sooner than 84 months after the initial placement, with specific restrictions on pontics and retainers.
Benefits will be considered only for the initial replacement of a necessary functioning natural tooth extracted while the person is covered under the plan.
All-On-Four
Cigna dental insurance typically does not provide specific coverage for All-on-4 implant solutions. Most plans exclude comprehensive implant-based full-arch restorations. While individual components like dentures may be partially covered, the complete All-on-4 procedure would likely be considered an out-of-pocket expense.
How to Use Your Cigna Dental Insurance at PDIS
Using your Cigna benefits effectively requires proper planning and documentation. Our team helps guide you through each step:
Verification Process
Our dedicated insurance team conducts a comprehensive verification of your Cigna dental benefits before your initial appointment. We systematically review your specific plan type, examining the nuanced details of your coverage, including annual maximums, service limitations, and potential benefit restrictions.
Pre-authorization Requirements
Cigna dental plans may require prior authorization for several critical dental procedures, including crowns, periodontal services, and certain major treatments. Our experienced team manages the entire pre-authorization process, submitting comprehensive documentation that demonstrates medical necessity.
Coverage Tiers and Network Details
As a Cigna participating provider, our practice offers patients significant advantages through our in-network status. Depending on your specific Cigna plan, coverage varies across different service categories.
Understanding Your Out-of-Pocket Costs with Cigna Dental Insurance
Pacific Dental & Implant Solutions is committed to helping patients understand the financial aspects of their Cigna dental insurance coverage, ensuring transparency and minimizing unexpected expenses.
Deductibles
Cigna dental plans feature varying deductible structures:
- Most plans include an annual deductible ($50-$250 per person)
- Deductibles typically apply to basic and major services
- Preventive care is often exempted from deductibles
Copayments and Coinsurance
Cigna dental insurance utilizes a structured copayment system:
- Preventive services: 0% copayment
- Basic procedures: 20-25% copayment
- Major services: 50% copayment
Annual Maximums
Cigna dental plans offer different annual maximum benefits:
- Individual plans range from $1,000 to $5,000
- Some plans feature innovative benefit structures
- Specific limitations based on plan type
Next Steps: Schedule Your Consultation
Ready to use your Cigna benefits at PDIS? Schedule a consultation below. When you visit, please bring along your insurance card and a valid photo ID. We also recommend preparing a list of your dental concerns and bringing any previous dental records you may have available.
Having these materials ready will help us provide the most comprehensive evaluation of your needs and insurance coverage. We look forward to serving you soon!