Thursday, June 26, 2014

Is Your Insurance Company Trying to Decide the Treatment you need?

            If you have dental insurance, chances are you pay hundreds of dollars each year to cover your family for the basics and in case something goes wrong. So if the time comes along that a major procedure is warranted, shouldn’t your insurance provide some help in covering a procedure that will give you the best long term result? The answer should be yes, but you will be disappointed to learn that this is not always the case.

            A common example of dental insurance trying to dictate the treatment you need is when you want to replace missing tooth with a dental implant over a dental bridge. Dental implants are long lasting, cosmetic, functional, and are non-invasive to your other teeth. Over the course of your life, they typically result in the least amount of long term financial investment because they will last longer than a dental bridge. This also means the insurance company will have to contribute less over the long term.  But for whatever reason, many insurance companies will deny you coverage on the dental implant but will approve the dental bridge. Both procedures require a large financial commitment, and the difference in coverage is often the difference maker if you need your tooth replaced. Thus, the insurance company can push you towards one option over another.

            So what can we do if your insurance company denies coverage to a recommended procedure? In some cases, no matter what we do, the insurance company will simply not provide any coverage for certain procedures. But in other situations we can submit a new request for coverage along with a narrative explaining our rationale for the treatment needed. There are times when reason wins and coverage is granted, but unfortunately it doesn’t always work out that way.

            Before signing up with an insurance carrier or package, I would recommend doing some detailed research on what procedures may be covered. If you are overwhelmed by all of this or confused, I encourage you to call us and we can help you sort through what plan may be best according to the needs and dental history of you and your family.

For more information, visit

Lee T. Brown, DDS
Brown and Kupper, DDS Inc.

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