Does Medical Insurance Pay For Dental Trauma?

Spring is approaching, and as the warm weather beckons both children and adults outside, incidents that require a trip to the family dentist will occur with greater frequency. However, these types of dental mishaps are often only partially covered by dental insurance. Dental trauma coverage by medical insurance plans varies by carrier, and some dental related injuries are not covered because of an individual's dental history.

What kind of dental trauma is not covered by medical insurance?

Generally, any trauma that occurs inside the mouth, such as biting down on a hard object and breaking or loosening a tooth, is not covered by medical insurance. These types of injuries are reserved for dental insurance or cash payment.

However, there are some medical insurance carriers that place restrictions on coverage, depending on the prior dental history of the victim. For example, if a tooth is knocked out from a playground or sports related injury, some medical insurance carriers pay for dental treatment with the same level of coverage as any other physical injury.

The wording of the insurance policy is often used to determine whether coverage will be approved or denied. Many policies will agree to repair or replace a "sound" tooth that has been loosened or knocked out. 

Some medical insurance carriers will then look at the individual's dental history to see if the tooth has been previously replaced, or has had issues such as tooth decay. The definition of a "sound" tooth may vary according to the patient's insurance company.

Some medical insurance carriers define a "sound" tooth as an original tooth, free of health issues that may have caused it to fall out prematurely on its own. Others may determine it as any tooth, original or replacement, that was viable directly before the incident occurred.

How can medical insurance customers know if they are covered for dental trauma?

The only way to know for certain about the extent and limitations of coverage for dental trauma is to contact the individual insurance company directly. Ask about terms such as a "sound" tooth that may be defined in different ways.

If you find that coverage is inadequate, and you or members of your family engage in activities with a higher risk of dental mishaps, ask if a rider can be attached to your policy that provides additional coverage beyond your existing policy.

This may also be a good time for a family conversation on the importance of protective mouthpieces in sports and other activities that pose a risk of dental trauma. For more information, contact a family dentist like Four Corners Dental Group Fairbanks.