Posted on: 27 January 2017
One of the things you may notice on your dental insurance is an area for medically necessary cosmetic procedures. You may be wondering what this refers to and what procedures may fall under this categorization. Knowing this information could mean the difference between not having enough money for the procedure or not being able to have the procedure covered by your insurance at all. Here are some signs that your planned cosmetic dentistry procedure is necessary.
Preventative Medical Necessity
One of the categories your dentist may use for the procedure, such as implants, is having them labeled as preventative medical necessity. This means that the dentist has decided that a cosmetic procedure, like dentures or dental implants, is necessary for your oral health and to prevent further issues. For example, if you are having degenerative bone issues in your jaw, your dentist may decide that anchoring implants are necessary to prevent further degeneration in areas or from issues with current cosmetic procedures like dentures.
In some cases, it is not the actual procedure that is marked as necessary, but the referral to a specialist, that does the trick. For example, you may go see your dentist to have a cosmetic procedure, such as dentures or dental implants, done. The dentist may find something during the consultation that shows an underlying medical issue requiring a referral to a specialist. Your insurance may consider this referral, and anything the dental specialist orders for treatment, as a necessity. This moves the procedure from a desire to have done to a medical need thus changing what amount is covered under insurance.
Emergency Cosmetic Procedures
There are some cases when you may have a dental emergency that requires what would normally be considered as cosmetic to be done. For example, you may be in a situation like a car accident that has knocked out several of your teeth and damaged your gum line and jaw. Dental implants to replace the missing teeth may be the first step while bone grafting may be used to rebuild the jawline and form an even layer for the implants may also be ordered in extreme conditions. This would place them as cosmetic but necessary.
These are only a few of the examples that may arise which would change a typical cosmetic dental procedure from a request or option to a medical necessity. Again, this change does change what is covered under insurance and how much is covered of the dental procedure. If you are unsure what your insurance will cover, ask your dental office like that of Davis R Troup DDS PA or contact your insurance provider when the procedure has been ordered.Share