No Frequency Limit on Emergency Services
The CDCP has a limit on the number of times you can seek specific dental services. Any services beyond that limit will require pre-approval. Emergency dental care in 2025 doesn’t have a frequency limit so you can go see your dentist in an emergency as many times as you need.
Some Services Overlap
Emergency dental care covers an initial exam, diagnosis, and pain management. Other procedures given as part of emergency dental care aren’t addressed in the guidelines but could be included under other covered services such as “major services” or “diagnostic services.”
Surgery, such as what would be required to reinsert a knocked out tooth, could be covered under the CDCP whether it’s in an emergency dental visit or through a regular dental exam.
In most emergency dental situations, the patient is examined, diagnosed, given pain relief and perhaps antibiotics for infection. They are scheduled to follow-up the next day with their dentist. Their dentist decides on any necessary dental procedures.
Your dental provider will file a separate claim to the CDCP to pay for these types of services. The claim wouldn’t be labeled emergency service but would likely fall under any of the many other allowable categories.
Don’t opt for skipping the follow-up because you are worried about how it will be paid. Talk to your provider about how payment is made under the CDCP.
Some Will Pay a Co-Payment
The CDCP operates on a type of sliding scale for those with a household adjusted net annual income of less than $90,000. Some on the lower economic end will not be required to make a co-payment for any medical service while those with higher incomes will be required to pay a percentage in a co-payment.
Three circumstances where you will likely be required to pay a co-payment include:
- Your household adjusted family net income falls between $70,000 and $89,999.
- The CDCP reimbursement rate for services is lower than the cost of services.
- You agree to pay what the CDCP doesn’t cover prior to services being rendered.
Those receiving dental services through the CDCP will never pay the full cost of services at the time of service. You will be expected to pay the stipulated co-payment directly to your provider.
You should ask and understand how much the provider is charging for services compared to what the CDCP is paying. Some providers may charge additionally for services beyond the CDCP fee schedule. Even those who don’t have a co-payment will be required for the additional cost.
Also, understand which services are covered by the CDCP and which are not. You will be responsible for services given that aren’t allowed for reimbursement under the CDCP.
Another piece of information you should have is how much your co-payment percentage is of the bill. The percentage is figured using the CDCP fee schedule. Patients will need to pay that plus any additional fees for services where the cost is more than allowed on the fee schedule.
For instance, a patient with a 40% co-payment gets a medical service that is billed as $200 by the dentist office. The CDCP has a fee schedule of $160 for that service. The patient will be required to pay $64 as a co-payment plus the other $40 for a total of $104.
There could be some restrictions on how you pay the dental office as well, depending on their policies and CDCP requirements. For instance, budget billing isn’t allowed in some cases.
Those who need further explanation can visit this website. We are happy to go through information with you to help you understand what procedures are covered and what the final cost will likely be billed.
Emergency Dental Care FAQs
No, you will not get turned away for participating in the CDCP program. Emergency visits are covered in the program.
Emergency dental care could cover major dental surgeries in certain circumstances. However, that doesn’t mean the CDCP will cover all costs stemming from emergency dental care.
Basic emergency dental services don’t require pre-approval by the CDCP. That typically includes an exam, an X-ray, and diagnostics. It likely will include pain management or a prescribed antibiotic.
Dental practices have their own policies on how they accept walk-in patients.