Cosmetic Dentistry Procedures that Dental Insurance Doesn’t Cover

Dental insurance generally won’t cover these cosmetic dentistry procedures:

  • Porcelain veneers, when placed for the first time, because they are usually done for the sake of appearance only. See below for exceptions to this.
  • Bleaching or tooth whitening procedures will be denied by your dental plan. There is no way to get around this. Tooth whitening is always a cosmetic procedure.
  • Bonding to correct a space between your teeth (a diastema), when it’s done for the first time, is almost always not covered. Tooth bonding for other purposes may receive some coverage.

Situations in which dental insurance will often provide benefits for cosmetic dentistry:

  • Replacement porcelain veneers, if the original veneers have deteriorated. There is a clause in most dental insurance contracts that requires the company to reimburse for the replacement of defective dental work, and there is usually not a restriction for the type of dental work that is being replaced. If the deterioration of the porcelain veneers is documented, then replacement veneers will often be approved.
    However, a word of caution is important here. Usually, the insurance company has a low-level clerk whose job it is to initially screen the claims. This clerk is told to reject any claims for porcelain veneers because they are cosmetic. A successful technique for working around this bureaucratic obstacle is to submit first a pre-treatment estimate to the company documenting the deterioration of the porcelain veneers and proposing to replace these with porcelain crowns. This will then come back approved. Then, the office can write back to the dental insurance company with a revised pre-treatment estimate saying that you have decided to replace the worn-out veneers with new porcelain veneers. Usually, that proposal will come back approved. Don’t expect the porcelain veneers to be covered completely, but you will get some benefits for the procedure.
  • Braces for straightening your teeth (orthodontics), are covered by many dental plans. Usually it is an optional coverage that you can elect when you sign up.
    If your dental plan includes orthodontic coverage, you may be able to get porcelain veneers covered in lieu of braces. Again, to avoid the automatic rejection you will face from the clerk when the word “porcelain veneers” shows up on your pre-treatment estimate or your claim, first submit all the documentation required for the approval of orthodontic coverage. If that is approved, then send in a second estimate saying that you’ve decided to do porcelain veneers in lieu of braces. Many times the dental insurance company will provide some benefits for the veneers in those circumstances.
  • A chip or other damage to a front tooth
  • Any other repair after an injury. In the case of an injury, don’t overlook other insurance plans. Medical insurance plans often have a provision for covering the repair of an injury. Liability plans or workmen’s compensation plans that cover the site on which the injury occurred may also come into play.

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