Quick Answer
Most U.S. dental insurance plans (Delta Dental, Cigna, MetLife, Aetna, Guardian) will reimburse a portion of treatment received in Mexico under your out-of-network benefits, typically 40–60% of the usual-and-customary fee after deductible. You pay the Tijuana clinic in full, then submit an itemized claim and receive a check from your insurer 4–8 weeks later.
How Out-of-Network Reimbursement Works
Every U.S. PPO plan has out-of-network benefits. The insurer pays a percentage of their 'allowed amount' (the usual-and-customary fee in your ZIP code), not what the Tijuana clinic actually charged. Because Tijuana fees are lower, you often pay less out-of-pocket than you would for in-network care after the reimbursement check arrives.
Realistic Reimbursement Examples
Single implant: Tijuana fee $2,000; U.S. allowed amount $2,800; 50% reimbursement = $1,400 back. Your net cost is $600. Crown: Tijuana fee $600; U.S. allowed amount $1,400; 50% reimbursement = $700 back — meaning the insurer reimburses more than you paid, capped at the actual fee paid.
What You'll Need to Submit a Claim
An itemized receipt with CDT procedure codes (American Dental Association codes), the dentist's name and license, treatment dates, your insurance member ID, and a completed claim form (downloadable from your insurer's website). Border Care Dental's partner clinics issue claim-ready receipts with CDT codes.
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View TreatmentsPlans That Usually Reimburse
Delta Dental PPO, Cigna DPPO, MetLife PDP Plus, Aetna PPO, Guardian PPO, United Concordia, and most employer-sponsored PPO plans. HMO and DHMO plans typically do not reimburse out-of-network and won't pay for Mexico treatment.
Annual Maximums Matter
Most dental plans cap annual benefits at $1,500–$2,500. For a large implant case, you'll hit the maximum on Trip 1 and won't get more until the calendar year resets. Patients often time Trip 1 for late December and Trip 2 for early January to use two plan-year maximums.
Insurance & Claims
We help you prepare a clean reimbursement claim.
Our partner clinic provides ADA-coded invoices and dentist credentials — the documentation U.S. insurers need to process out-of-network claims.
How It WorksMedical Insurance for Implant Cases
If your dental work is medically necessary (e.g., reconstruction after trauma, congenital missing teeth, or jaw surgery), some medical insurance plans will cover part of the cost. This is rare but worth checking for complex full-mouth cases.
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