The unfortunate truth is that many dental insurance providers will not cover anything that falls under the term "cosmetic." This is especially true of dental implants. However, there are some instances when your medical insurance can cover implants. In these cases, your need for implants have to constitute a medical necessity.
Medical Insurance and Dentistry
Your medical insurance policy may have direct clauses related to dental work. Since policies vary by insurer and options, you should take a moment to look through your medical insurance policy carefully. If a copy of your policy is online, see if there's a search feature.
Or, you can press CTRL+F to bring up a search in the webpage. Look for words like "dental" and "dentist." There's a good chance that some clauses will pertain to outlining when dental work is a covered medical necessity. If you cannot find anything, ask your medical insurance provider directly.
In general, many medical insurance carriers consider dental work a medical necessity if the dental problem can affect the whole body negatively. They may also consider dental work a medical necessity if you have a bodily illness that can adversely affect your dental health.
When Are Implants a Medical Necessity?
Here are a few examples of issues where dental implants can be considered medically necessary.
- If you cannot eat properly – Dental issues can have an adverse effect on your health if they don't allow you to eat properly. Even if you already have a solution like dentures in place, it's possible you're not eating as you should, or you're losing weight because of changed eating habits. The inability to receive proper nutrition, for any reason, can very well fall under the category of "medical necessity." If implants can fix the problem, there's a chance your medical insurance will cover them.
- Bulimia nervosa – Bulimia can cause severe damage to teeth. It can cause so much damage that it can become detrimental to keep the teeth. Usually, having the teeth removed or repaired will fall under dental insurance. Implants can become a medical necessity if they're a part of the overall treatment of bulimia.
- Sjögren syndrome – This autoimmune disease destroys glands that produce saliva and tears. Besides its other devastating effects, it can also cause absolute dental ruination. Sometimes, patients with this disease will need many of their teeth pulled. Once again, this disease happens to also affect the teeth. So it's possible medical insurance will cover it.
Speak to a Cosmetic Dentist about Your Options
Outside of implants, there are many things that a dentist can bill to your medical insurance. Understand that this works on a case-by-case basis, so you have to bring up the possibility with your dentist.
The cosmetic dentist may know precisely how to go about billing your procedure as a medical necessity. He or she may also have the ability to negotiate with your insurer to help you out.
Many of the things that constitute a "medical necessity" are fairly open to interpretation. It all depends on the precise wording of your policy, your particular dental issue, and your cosmetic dentist's ability to negotiate.