Dental insurance will help pay for some cosmetic dentistry procedures, but you need to understand something about the limitations. Often cosmetic dentistry is doing a needed dental procedure so that the end result looks beautiful. For example, let’s say you need a crown on your front tooth. You can crown that tooth with a porcelain fused to metal crown that approximately matches the adjacent front tooth and then later develops a dark line at the gumline. It’s not beautiful, but it structurally repairs the tooth. A cosmetic dentist will want to repair that tooth with an all-porcelain crown that is carefully color matched to look identical to the adjacent tooth and is beautiful in every respect. While your dental plan will help you pay for the more beautiful crown, they will limit what they pay. Let me explain.
The first thing you need to understand about insurance companies is that they exist to make money. They don’t have a mission to help you, the patient. Their mission is to make a profit for their stockholders and a nice place to work for their employees. So don’t be shocked when they refuse to pay for dental treatment that you want.
In order to keep costs under control, they will set up strict limitations on benefits. For example, if you have a cavity, they will pay for the least expensive treatment that fixes that cavity in an acceptable way. Usually that means a silver amalgam filling. Most people today, however, prefer the white fillings. Dental insurance companies often object to the white fillings not because they’re inferior to amalgam fillings, but because they’re more expensive.
The same goes for other services. If you need a porcelain crown on a front tooth, they will pay for the least expensive practical alternative. This usually means a porcelain fused to metal crown. Well, porcelain fused to metal crowns are opaque, fake-looking, and they tend to develop a black line at the gumline after they’ve been in your mouth a while. You may think that’s ugly. The company thinks that’s fine. You say you want a beautiful all-ceramic crown that perfectly matches your other teeth, so that people can’t tell you have a porcelain crown. That raises the cost beyond what your dental plan wants to pay. Is that unfair? I don’t think so. Just pay the extra and get the crown done the way you want to. You’re the one that has to live with it—don’t let your dental plan tell you what kind of crown to get.
In my private practice, I was a cosmetic dentist. Cosmetic dentists go through a lot of extra training and use expensive dental laboratories, expensive materials, higher-paid staffs, and take extra time with their procedures. For all of this investment, they don’t get any legal recognition as a specialist, the way an oral surgeon would, for example. So when a dental insurance company looks at the fees that a cosmetic dentist charges, they think of this dentist as a “general dentist.” Legally, that’s what he or she is. Dental insurance companies tend to not like expert cosmetic dentists. But if you want beautiful cosmetic dentistry, don’t let the insurance company talk you out of it.
There are also some cosmetic dentistry procedures that they don’t cover at all, usually. Click here to read more about dental insurance and cosmetic dentistry.
Delta Dental plans are a little different in how they pay. They will expect a dentist to agree to their fee schedule. For this reason, many cosmetic dentists choose not to participate with Delta Dental, or other similar fee-limiting dental plans.