Many people choose to carry dental insurance to offset the costs of semi-annual cleanings and just in case something major goes wrong. So what happens when something bad happens? Will your insurance help cover a procedure that gives the best long term result? Unfortunately, your insurance may have limitations on what procedures they believe they should help.
An example with frequently deal with:
A tooth is missing or must be extracted. You want to replace the missing tooth with a dental implant over a dental bridge. The implants are usually longer lasting, easier to clean, and do not require invasive drilling on your other teeth. Over the long term, they typically result in the least amount financial investment because they will last longer than a dental bridge. Logically speaking, this also means the insurance company will have to contribute less over the long term, which is what they are after. But for some reason, many insurance carriers will deny you coverage on the dental implant but approve the dental bridge. Both options require a big financial commitment, but the difference in coverage can be a difference maker if you need your tooth replaced. The lapse in dental implant coverage can push someone towards a procedure that doesn’t necessarily have their best interest in mind.
So what happens if your insurance carrier denies coverage on a recommended treatment? There are times when no matter what we do, insurance will simply not provide any coverage on a recommended procedure. 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 many insurance carriers are very slow to change their policies to the recommended standards of care.
We recommend that before you sign with an insurance carrier or package that you do some detailed research on what procedures may be covered. If this seems overwhelming or confusing, 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 www.dentistwestchester.com.
Lee T. Brown, DDS
Brown and Kupper, DDS Inc.