dental insurance that covers cosmetic

Dental Insurance That Covers Cosmetics

Is there such a thing as dental insurance that covers cosmetics? Two key words here- medical necessity. If you have been in the insurance world longer than five minutes, the phrase medically necessary is one you know well. If you have ever called your insurance company and asked if a certain procedure was covered, often or not you were told it would be covered based on medical necessity.

The first key point is your plan would have to have the benefit. For example, the plan itself would need to have some option of cosmetics attached to it. If you have a medical problem such as sinus, you can ask the team of RhinoplastBrisbaneCost clinic explains about sinus problems leading to toothache and check if your insurance covers the procedure for the treatment for your sinus. The benefit itself might read, cosmetic procedure covered based on medical necessity. That would be the first cue to have a procedure covered.

What does covered actually mean? The insurance pays everything and you pay nothing? This is where you would need to understand how your insurance benefits work. Just because something is “covered,” doesn’t mean covered in the sense that you have nothing to pay. Covered, just means you have the benefit for cosmetic procedures, then the insurance will process the claim and pay it accordingly. This step is called prior authorization, it is where the doctor submits the reason for your procedure.

Say in this example, there was an accident. Your daughter was playing softball and got hit hard right in the jaw. She ends up having a few cracked teeth. Your dental plan states cosmetic procedures are covered under your plan in the case of an accident, based on medical necessity. If you have a deductible that needs to be paid first, $3000- guess who is paying for that first $3000? You are! The insurance is agreeing to process the claim since it is a covered benefit under your plan, but you are paying that full amount first. Often at times after the deductible is met, the insurance will pick up a portion of the bill, but so will you. This is called your co-insurance. There will be a percentage allowed of what the insurance pays and what you pay, say 40% you and 60% the insurance company. So the insurance will pick up 60% of the cost allowed and you will be paying the other 40% up until your maximum out of pocket is met.

Most insurance companies do not cover cosmetic procedures without a reason for it. If you have the benefit for cosmetic procedures and the doctor can undoubtedly show the reason for it, then it may be covered. Covered in the sense that the insurance will process the claim, remember you still might have to pay!

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