In short, my son was born without his permanent laterals. These are the teeth between the canines and the incisors.
He is now done with his braces, and we are going to have to get permanent laterals implanted for him sometime within the next year.
Problem is, our dentist says the insurance company will not pay for them, because they’re considered cosmetic. My stance is this is a congenital defect that should be covered.
What can I expect? I haven’t gotten to the point yet where I’m fighting with the insurance company. He just had his retainer put in, and he has a dentist appointment next month, and I plan on discussing the procedure then. When the insurance company turns me down, what do I do? How should I appeal this? What are my chances?
Does your insurance cover “cosmetic” birth defects? Were you insured by this company at the time of his birth?
Is this health insurance, or dental insurance? My health insurance will only cover damage to “sound, natural teeth” and will only cover cosmetic surgery for accidents or mastectomies.
I guess what I’m saying is that you’ll have to take a look at your coverage and see what they cover and what they don’t.
It’s through my work, and this is the dental portion. I have a separate policy for health.
My son is 14, but my children have been covered since I started with this company, about five years ago. We’ve also switched dental polices about three times, so I’m not sure what’s covered and what’s not.
I guess I better make a phone call to the insurance company.
I wonder if you could argue that it could prevent future jaw problems? My husband got braces as an adult to prevent further deterioration in his jaw that was being caused by a misalignment. He should have had braces as a child, but couldn’t afford it.
Your dentist might be able to present the case that the teeth are needed to maintain a healthy bite. I would think that not having them would undo a lot of the work done by the braces, wouldn’t it?
ivylass, most dental policies pay nothing for any procedure related to implants. It’s not the insurance company that is the sticker here. It is what the employer is willing to have in the dental contract. In a very few cases the policy will pay something toward the crown that goes on the implant, even if the implant itself is not covered. Yes, that is a separate procedure with a separate charge. Just one implant plus the implant supported crown can cost over $2500, dwarfing your yearly maximum benefit.
It seems ortho treatment was planned to allow implants. It is not a medical or dental necessity to have laterals. Any correction is considered cosmetic.
Look at your medical policy. Some may pay for dental services only if needed due to accident or impacted wisdom teeth. A few of our patients had policies that covered the implant but not the crown. None of these were for cengenitally missing teeth. All had implants at extraction sites and surgery had to be performed by a periodontist or oral surgeon in a hospital type setting. The congenital defect aspect of it will have nothing to do with whether you get any benifits this way. It will again be a matter of what the insurance contract with your employer allows.
E-mail if you want. Address is in my profile. Dental insurance takes up about 75% of my working day. sigh