Dentures are important restorative dental devices. They can be used to replace missing teeth, strengthen your jaw and improve your overall oral health. However, many insurance companies don't provide comprehensive coverage for dentures. They often cover a small fraction of the cost, and you may be lucky to receive 50% coverage for your denture expenses. This often causes patients to have to incur high costs out of pocket.
There are several ways through which you can compel your dental insurance company to cover a significant portion of your dentures. The key is to establish an authentic medical connection between the dentures and your overall health. If you can convince the insurance company that your dentures are essential moving forward, you can make a strong claim for coverage.
Consider these four important factors when approaching your insurance company for coverage.
1. Are your dentures medically necessary?
Most insurance companies follow a simple process when examining claims. They look to see if the claim is medically necessary, not medically necessary or experimental in nature. Your goal is to convince the insurer that your dentures are critical towards your oral health. This is not difficult to achieve, as the importance of dentures is widely known.
If you have missing teeth in your mouth, the consequences can be extensive. Plaque, tooth misalignment and infections often occur in areas where the gums are exposed. Work closely with your dentist to determine why dentures are necessary for your oral health moving forward. Your claim should have a strong medical connection between the need for braces and how they will help with your dental health.
2. Gather enough medical evidence
Strong medical records form the basis of any insurance claim. You may be in need of dentures to strengthen your jaw and prevent further tooth loss, or your dentures may be part of a comprehensive treatment plan following dental trauma.
Regardless of the reason, make sure you have all essential medical records handy. Include the type of dentures you need, how long you'll be wearing them for and how they will benefit your oral health over time.
3. Determine if other insurers provide coverage
You can also use an element of peer pressure to compel a stubborn insurance company when filing a claim. Do your homework and look for dental insurance companies that provide better coverage for denture installation. You can then refer your insurer to these companies and use the same basis as a claim for coverage.
Remember that insurance companies have a fiduciary duty to provide reasonable coverage to their patients. If your insurer is ignoring clear medical evidence for coverage, you often have sufficient grounds to file an appeal.