Why Is My Insurance Company Calling Dental Implants a Cosmetic Procedure?

 / Why Is My Insurance Company Calling Dental Implants a Cosmetic Procedure?

Why Is My Insurance Company Calling Dental Implants a Cosmetic Procedure?

I was in an ATV accident and lost both of my front teeth as a result. My dentist recommends dental implants and I’m all for it, but they said insurance isn’t going to cover much. Supposedly it’s cosmetic? I’m confused. Isn’t having teeth necessary? How on earth can they consider replacing them to be a cosmetic dentistry procedure? Is there a way to get insurance to pay more for dental implants?

-Randolph in Minnesota

Dear Randolph,

Yes, having teeth is necessary, especially if you like eating. It’s also important to get going on replacing them fast, because your remaining teeth will start to slide into the empty space they left behind. The problem is that most insurance companies recognize the need to replace them, but not to restore your smile with the best possible solution. Because there are less expensive methods that are, in their opinion, good enough, the better method is considered “cosmetic.” What they’ll generally do is cover the cost of a less expensive procedure, like a dental bridge, and have you pay the difference. Or they’ll pay for a just a portion of the dental implant, such as the crown that sits on top.

With that said, it doesn’t sound like your office requested a preauthorization or a predetermination of benefits from your insurance company. With larger procedures like this, it’s not a bad idea to have the office send off all the details to the insurance company and get them to officially state what they will and won’t pay for with your procedure. Depending on how your policy is written, you may have benefits that other plans don’t, or they may pay more for your treatment if they receive a letter from your dentist saying why the more expensive procedure is necessary. So, although dental implants are not really a cosmetic dentistry procedure, some insurance companies may process them as such because it means they’ll pay less.


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