Why Does My Dental Insurance Not Cover That? (continued)

This is the third blog in a series intended to provide helpful information about dental insurance.

Have you ever been told that a dental procedure you want/need is an “excluded item”? It is an event that can be frustrating for both you and the dentist. This is an aspect of a policy that can have a positive effect regarding the cost of the monthly premium. However, the negative effect of that aspect will cause you to pay Out of Pocket for a service. The decisions made on “excluded items” are made by the employer, or by the individual owner of the policy.

One very popular “excluded item” is a Sealant for adults (anyone over age 14 or so). Many policies cover sealants for children, but not adults. By having this excluded item, the insurance company will not be required to pay for the service, thereby saving money for the insurance company. The frustration here stems from the fact that sealants are a tremendous preventive dental procedure which can be applied easily, quickly, and preserve the tooth structure from acid attacks (cavities). Given the option to “seal” a surface from a cavity, most preventive people would gladly accept the sealant, rather than hope the surface won’t get a cavity in the future. Sealants are easy, much less expensive, and painless. There are policies which restrict the teeth that are eligible for coverage, which is also frustrating. In this case, the policy may cover the procedure for molars, but not the teeth forward from the molars (these teeth often have areas which could benefit from a sealant).

Another popular exclusion is a Night Guard, or Occlusal Guard. For the people who either grind or clench their teeth, this device is a tooth-saver. It prevents broken teeth, and also eases tension on the jaw joint. Again, given the option to protect teeth from breakage, or to prevent painful jaw problems, most people would gladly accept the treatment, rather than watch teeth break one at a time over the years. The treatment is much less expensive than multiple crowns and/or jaw surgery.

By eliminating these two procedures from the list of “covered items”, the cost of the policy will be reduced. However, it is best to have a good dialogue between you and your dentist to make a decision on what will be healthier for you. It could be tempting to forgo a procedure simply because it is not covered by insurance, but you will come out the loser in the end.

When you experience some disappointment regarding a “denied dental claim” it will be important to remember that you and your dentist are partners in deciding your dental future. After all, what else can impact your life as much regarding your enjoyment of meals, your conversations, your smile and, don’t forget, your kiss!

Stay tuned for more about your insurance.