Most dental insurance plans cover preventative services like cleanings and x-rays as well as restorative procedures. The focus is on keeping existing teeth healthy and replacing diseased teeth rather than the aesthetics of your smile. That being said, here are a few things to consider when seeking coverage for a cosmetic dentistry.
FIND OUT WHAT YOUR INSURANCE PLAN COVERS
First things first, confirm whether or not any cosmetic procedures are covered by your insurance plan.
If you receive insurance through your employer, talk to your HR manager or supervisor about finding out what is covered. Dental insurance is not designed to pay the entire bill, it is there to aid in payment and it’s important to be familiar with your yearly maximum and deductible levels.
If you will be calling the insurance company yourself, gather all the pertinent information beforehand: the name on the account (if you are using a spouse’s plan), the group number, ID number, co-pay details, etc.
Services like clear orthodontic aligners (commercially known as Invisalign), whitening, veneers, composite bonding, crowns, bridges, implants and gum reshaping all have the possibility of being considered cosmetic. Here are a few tips and common stipulations about each of these procedures.
- Invisalign: Typically not covered and can cost around $5,000.
- Whitening: Very rarely covered because it does not improve the health of your teeth. Generally costs between $250-$500.
- Veneers: While it is very rare that insurance would help cover the cost of outfitting you with a set of veneers, some plans do help pay for the cost of replacing or repairing them. It’s important to designate that it is a repair on deteriorated work. Ask your dental billing specialist to be sure to use the words repair or replace when submitting the claim to the insurance company. These tiny details can make a big difference! If a claim is submitted and it doesn’t specify that it is replacment, your insurance company is likely to dismiss it immediately. Veneers can cost as much as $1,000 to $1,500 per tooth.
- Bonding: If your dentist is fixing a tooth after a chip or scratch from an injury, you may be able to get it covered since it is a “repair.” Be sure it it submitted as such. It typically costs around $100 to $400 per tooth depending on the area repaired.
- Crowns & Bridges: Of all the procedures on this list, crown and bridges are more likely to be covered if you can prove that it is being done to support a weak tooth or repair a cracked tooth. If it is being done simply to improve your appearance, it will likely not be covered. Another tip with crowns is to ask you dentist what type of material he will be using in the crown. For example, if the crown will be going in the back of your mouth and made from amalgam it has a higher chance of being covered than a porcelain crown. Crowns and bridges can run as much as $1,500+.
- Dental implant: Typically not covered. However, some insurance companies will cover the cost of bone grafting or the sedation that is sometimes necessary for an implant. They generally cost around $4,000.
- Gum reshaping or contouring: Because it is purely cosmetic in nature, it is typically not covered. The price of gum contouring varies greatly because it can be just a simple contour on just a couple teeth or it could extend to be your entire mouth, anywhere from $300 to $3,000.
While these estimates can give you the bigger picture, the bottom line is this: every plan is different! Get the right information straight from the source, your insurance company!
SPEAK THEIR LANGUAGE
Insurance companies have their own jargon the more familiar you are with it, the better! Often times you will be speaking with someone on the phone who has been trained to respond to certain key works but might not offer important information unless they hear those specific words. Forbes reports that only 14 percent of Americans who have insurance understand basic concepts like deductibles, copays and an out-of-pocket-maximum.
Understanding terms like yearly maximum, deductible, exclusion, limitations and waiting period can help you immensely! For example, after you have asked if a procedure is covered, double check by saying, “Are there any exclusions, limitations or waiting period on it?” The American Dental Association has this fabulous glossary available. Search for the specific procedure you are asking about or if you are feeling motivated read the entire thing!
EXPLORE LESS EXPENSIVE OPTIONS
Sometimes an expensive veneer is the only way to get your smile exactly the way you want it, but always ask your dentist if there is another method that might work. For example, shaping the tooth by shaving off rough edges or whitening your teeth might give you the look you are going for much cheaper. And sometimes if you can prove that your treatment plan is the least expensive way to fix the problem, your insurance company might be willing to pay for it.
SEEK OUT A DISCOUNT PLAN
Your insurance company might have a discount plan available for cosmetic work. In these plans, you will save a percentage of the final cost by using in-network dentists and specialists. Discount dental plans are also available to purchase from third parties.
CONSIDER FINANCING OPTIONS & CARECREDIT
While your household budget might not allow you fork out thousands upfront for a cosmetic dental procedure, you may be able to pay for a small portion of it monthly with financing.
Most dental offices have financing options available. As your billing specialist about how much you can finance, how long your term is and if there are interest charges or late-payment penalties. You will be surprised how much easier things can be if you just ask!
There are also health care credits cards you can use. According to DearDoctor.com, the most common is CareCredit that is offered by GE Capital. It allows you to charge procedures up to your credit limit and then make a monthly payment. Typically, the interest rate is around 14.9 percent but you might quality for a promotional no interest period. Like any credit card, they late fees and penalty interest rates can get steep so only choose this options if no other options are available and if you are confident you can make the payment.
PREAUTHORIZATION IS YOUR SAFETY NET
One of the good things about cosmetic dental work is that it is typically not urgent. This means that you can spend ample time getting your treatment pre-authorized by your insurance company. A pre-authorization estimate is an outline of who will pay for what on a particular procedure. Even if you will be paying more than you would like, you will know exactly what you are responsible for. While it is possible that things could change, a pre-authorization will be an amazing tool to leverage. And like most things in life patience, persistence and politeness will go a long way! Endure it and you won’t wind up with a hefty unexpected bill.