Learn the Services Dental Insurance May Cover from a Cosmetic Dentist

Sometimes it’s difficult to know whether a dental service you need is classified as a cosmetic treatment or a restorative one. If you’re used to using dental insurance to cover preventive treatments but are now dealing with a dental injury, you’re probably only now realizing how difficult it is to get insurance companies to cover your treatment. That’s why, according to a cosmetic dentist, you’ll need to know the right steps to improve your odds of getting coverage.

Here are the most important factors to consider.

Does Dental Insurance Cover Cosmetic Treatments?

For the most part, insurance companies will not cover any portion of cost for cosmetic treatments. This is because in order to get coverage, insurance companies need to confirm that you need the treatment for medically-necessary reasons, such as treating disease or decay, handling a dental injury, or to fix your bite. So, while the short answer is no, it doesn’t mean you can’t still get coverage for certain treatments.

What is Considered Cosmetic?

Generally speaking, cosmetic treatments are intended only for enhancing the aesthetics of your smile, not treating underlying or damaged teeth or oral tissue. If there is no medical reason for altering your smile or performing the procedure, it will generally not be covered. That means common treatments like teeth whitening, orthodontics and porcelain veneers/all ceramic crowns are not payable with insurance.

How Do I Get Covered?

As previously mentioned, insurance companies are more likely to cover your treatment if you can prove that it’s medically necessary. For example, if you’re getting crowns or even veneers placed, it should be noted that it was done so to restore diseased or broken teeth. This way, it emphasizes the medical need for the procedure.

If you are replacing veneers, rather than getting them for the first time, insurance is more likely to cover it since buffed-down teeth are not sufficient for daily use unless protected with veneers.

You’ll also want to consider if other treatments can accomplish the same goal, such as direct bonding. This can work to restore your teeth, but also have the added benefit of improving your smile’s appearance. The same goes for gum recontouring if you need to remove infected gum tissue via periodontal therapy.

Are There Other Ways to Prepare?

It’s key to use the right language when sending claims forms for your treatments, otherwise insurance companies will reject your claim outright. If you need new veneers, make sure to note that they are “replacements,” indicating that they’re necessary for protecting your teeth.

You can also benefit from performing a pre-authorization with your insurance. This is simply a document that covers who will pay for what before a treatment is provided, which can act as leverage when negotiating with your insurance.

Need help navigating your insurance for cosmetic treatments? Schedule an appointment today to learn more and get covered!

About the Author

Dr. Patrick Crowley earned his DDS degree from the University of Oklahoma College of Dentistry. He takes great pride in continuing his education on the latest cosmetic dental techniques in the industry with the most up-to-date technology available. To learn more about his practice or cosmetic treatments, you can contact him through his website.