Cosmetic Dentistry Procedures and Dental Insurance Coverage

Cosmetic Dental Insurance

Although the treatments covered by a dental insurance plan will vary from policy to policy, there is usually a general rule that excludes cosmetic dentistry procedures.

A dental procedure will be considered a cosmetic dental treatment if it is made for improving your appearance rather than correcting a dental health problem. Even if there is a real dental problem, the treatment your dentist may suggest (e.g. a porcelain crown) will not be always covered by dental insurance due to specific policy limitations.

Limitations of Dental Insurance Policies

Dental insurance providers attempt to reduce their costs by applying certain restrictions to your insurance policy. The most common clause used by dental insurance companies to allow them refuse to pay for expensive treatment that you may need, is a term called “least expensive alternative treatment” (LEAT), also known as the least expensive professionally acceptable treatment clause.

Under a LEAT clause, when there are multiple viable options of treatment available for a specific condition, the insurance plan will only pay for the least expensive treatment alternative. This means that, even if there is a dental problem such a tooth decay that requires a dental filling, which is a treatment covered by your insurance policy, you might find out that only amalgam fillings are actually covered.

Cosmetic Dentistry Procedures not covered by Dental Insurance

The following treatments are considered as cosmetic dental procedures and they are usually not covered by dental insurance:

Tooth whitening – Bleaching

Tooth whitening or tooth bleaching is a purely cosmetic procedure that will be denied by almost all the standard dental insurance policies. There is no way to get around this. Tooth whitening is always a cosmetic procedure.

Dental implants

Dental implants are likely to be excluded from a standard dental insurance policy. Dental implants is one of the most expensive dental treatments and their placement is considered a cosmetic dental procedure. When you have a problem of missing teeth, your dental insurance provider will only cover less expensive treatments such as a dental bridge or a partial denture.

Porcelain Veneers

Porcelain veneers is another cosmetic procedure that is unlikely to be covered by dental insurance. It might be possible to claim the cost of replacing defective cosmetic dental work from your dental insurance but not the cost of the original work.

Invisible / Lingual Braces

Basic braces are often covered by dental insurance but if you want something more sophisticated such as invisible braces then you will generally have to cover the cost yourself.

Tooth-colored fillings

Dental insurance policies cover the cost of amalgam fillings but if you want the more natural white fillings then you may have to pay the cost by yourself. Hawever, many insurance providers will cover you for tooth-colored fillings.

Tooth Bonding

Tooth bonding when done for cosmetic purposes, to correct the shape of a tooth or to fill a space between teeth (diastema), will not be covered. But in some cases when tooth bonding is used to correct a chip or fracture of a front tooth, the insurance provider may approve the cost or at least part of the dentist’s bill.

Porcelain Crowns

Dental crowns are the most common case where LEAT (least expensive alternative treatment) comes into action. If you need a crown your dental insurance provider is likely to insist on the cheaper option of porcelain fused to a metal crown. It might not look as natural as an all-ceramic crown, but structurally it will provide the same results.

Orthodontic Treatment

Please read the Orthodontic insurance coverage article

Before you take the final decision for a dental insurance make sure that you have asked for what is exactly covered in each case. Compare policies so that you get the best value for your money depending on your own needs.

Dental discount plans usually do not have any limitations regarding cosmetic procedures. If you are a member of a dental discount plan you will get a discount on a cosmetic procedure such as porcelain veneers exactly the same way you will get a discount for any other dental procedure.

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