Why Didn’t My Insurance Pay for Treatment

Dental insurance can be so confusing to understand.  Sometimes they won’t pay for something that you think they should. Let’s review some common areas in which claims may be denied and why.

Replacement Policy in Insurance

Most insurance policies have a replacement rule that applies to anything that may need to be redone or changed out.  For instance, this can be a denture, partial, flipper, crown or bridge. Commonly the time frame that an insurance policy states is around five years.  This means that, for example, if you have a crown done this year – that they won’t pay for a new one on that same tooth – for another five years.

So if you’re needing a new prosthetic, you’ll need to know how old your current one is.  This is something that our Raleigh dentist will need to submit with your insurance claim.

Missing Tooth Clause

Another stipulation is that some dental insurance policies have what is called a missing tooth clause.  Let’s say you’re looking to replace a tooth that’s been missing for a while. If you had the tooth removed while you were outside of your current policies coverage, then they may not pay for its replacement. In some cases, you could be looking at replacing several teeth with a partial, and even if just one of those teeth was pulled before you acquired their insurance, your claim could be denied.

Fluoride Treatments

Fluoride treatments have been proven to help fight cavities and reduce sensitivity.  What used to be part of a cleaning for a child has become a preventive method used across the board.  In this case, insurance companies haven’t kept up with the times. Most still only pay for children and young adults to have fluoride treatments. Costs are conservative and the benefits are great, so just because your insurance doesn’t want to pay for it doesn’t mean it’s not worth it.

Dental Implants

Every day more and more insurance companies are realizing the benefits of dental implants and paying towards them.  However, your policy may still be one of the ones that consider this treatment option as elective – denying all claims.

Waiting Periods

In some cases, certain benefits won’t be paid for as soon as a policy takes effect.  Usually, this is what is categorized as “major dental work” – like crowns, for example. So if you’re considering enrolling in a new policy because you need a lot of dental work, then you should look into the waiting period.  If one does apply, it can be as short as three months, or as long as 12.

Whitening Treatments

Teeth bleaching options are and will likely always be considered cosmetic dentistry.  The purpose of having dental insurance coverage isn’t to make you look good, but to keep you healthy instead.

Your Benefits Explained

If at any time you have a question about your insurance coverage, then feel free to give us a call.  Raleigh Dental Arts will be glad to help you in any way we can. If you’re looking for a great dentist in Raleigh, NC then you’ve come to the right place!

Tarun Agarwal

Dr. Tarun Agarwal, DDS is considered one of the top dentists in the country. He is a recognized speaker, author, and dental leader. He has been featured on CBS, NBC, ABC, FOX, and News 14 Carolina. Dr. Agarwal has been awarded '40 under 40' Business Leaders by the Triangle Business Journal. He is regularly invited to teach other dentists around the world and recently built a training center within the practice dedicated to sharing his expertise. Most importantly he is a loving husband and dedicated father of three wonderful children. His biggest accolade was being voted 'Best Dad in the World' by 2 of his 3 kids.