I have severe tetracycline staining and in need of about ten to twelve porcelain veneers. Will insurance cover any of this?
Can Insurance Cover Any of the Costs of Porcelain Veneers?
Doctor Answers 11
If your teeth have fillings or have had root canal therapy done, most likely you can get coverage for veneers. Without one of those conditions existing, most companies consider them purely cosmentic and provide no coverage. You can have your dentist submit a predetermination to the insurance carrier along with any documentation as to why veneers will benefit your teeth and hope for the best! But most companies will see no value in you having a terrific smile. Its an investment in yourself that can pay dividends for years to come.
Dental insurance usually will not cover porcelain veneers unless they are being used to restore a decayed or broken tooth. Tetracycline is not an indication the insurance company considers necessary for veneers. If the teeth are mottled, worn, or broken then you may get some coverage.
An interesting thing to know if that dental insurance was started in 1960 and the maximum benefits were 1K and it is over 50 years later and the maximum benefit is still usually 1K. This is absurd. Good luck and I hope that you enjoy your new smile.
Ronald W. Konig DDS, FAGD, LVIF
In 26 years I have definitely
treated a lot of tetracycline cases a lot of tetracycline stained teeth with
porcelain veneers and have ended up with patients that have had life changing
experiences and have said that every penny was worth it.Unfortunately insurance has not been very
much help with us. Tetracycline stain is
not really considered a disease its really more of an aesthetic issue…and
unfortunately there’s not a lot of coverage for that so expect to pay out of
pocket but if its done well its so worth your weight in gold.
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Some insurance plan will cover this procedure some will not. It is best to have your dentist submit a predetermination to the insurance company.
This way you will know ahead of time if you will receive any coverage.
If you have previous restorations, decay or chipping on certain teeth then you may be eligible for coverage.
Dental benefit plans, unlike medical insurance, are designed to help defray some of the cost of your dental care. Dental plan providers place limits and restrictions on how the benefits can be used.
Dental plans do not usually cover cosmetic procedures. Tetracycline staining is a side effect, not a disease. Veneers in this case, as in most instances, would be considered cosmetic and not a covered benefit. To be sure, have your dental office submit a pre-determination of benefits to verify benefit eligibility.
Over the years I have seen a small number of people get coverage for Porcelain Veneers. Have your dentist submit a preauthorization with radiographs and photographs along with a narrative. If your teeth have some existing restorations there is a chance for some coverage. Overall most insurance companies will not cover it but it is worth a try to get some coverage. Also keep in mind that if you need ten of them you will go way over your insurance maximum anyway. Best of Luck!
Most insurance plans that I have seen do not assist people if the treatment is being done for esthetic or cosmetic reasons. If you can give them a compelling functional reason that you are doing the veneers you may get some reimbursement. For example, I once had a patient who had a composite filling (tooth-coloured filling) on the edge of his front incisor that kept fracturing. I replaced it 2 or 3 times but it kept breaking. Fixing this problem with a veneer stopped the fracturing from happening. In this instance he was able to get assistance from his dental insurance because the veneer was done for a reason other than cosmetics.
Remember, most insurance plans have a yearly maximum amount that they will pay and that is usually small when compared to the overall cost of 10 to 12 veneers.
Tetracycline Staining is not considered a disease by insurance companies, but rather a cosmetic issue only. For this reason you would not get any insurance coverage for your veneers.
Unfortunately most dental insurances do not cover the cost of porcelain veneers. I say most because a few of the insurances happen to cover it. 95% of the time it will not be. Best thing to do would have the dentist submit a preauthorization to the insurance company.
My best advice is not to count on your insurance company covering any of the cost. Having said that, I have been surprised before. Make sure your dentist documents your case thoroughly and points out any fractures or decay that may be present. This may help with any possible insurance benefits.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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