Missing Tooth Clause With Insurance Companies

You have a missing tooth and go to the dentist to replace it. You just purchased dental insurance, so you feel confident you can get a restoration without spending much money. Then the receptionist tells you that your dental insurance has a missing tooth clause, and your procedure will not be covered. Find out what this means and how to avoid it.

What is a missing tooth clause?

When people purchase an insurance policy, it has a date when it goes into effect. Insurance policies that include a missing tooth clause will not cover dental restorations if the tooth was missing before the policy went into effect. If someone loses a tooth on June 1 and the insurance policy goes into effect on June 2, the policy will not cover the restoration.

The missing tooth clause can also include a waiting period. When that is the case, the policy will not cover a tooth replacement if the tooth was lost during this waiting period. Waiting periods differ from one insurance company to the next. However, waiting periods can be as long as five years.

Do all insurance policies have a missing tooth clause?

Most insurance policies have a missing tooth clause, but not all do. It is estimated that 90 percent of policies have this clause, leaving approximately 10 percent without the clause. Patients are encouraged to read the fine print before purchasing dental insurance to avoid this clause. Also, patients should get dental insurance before they think they need it. That way, they will have coverage, even if it has this clause.

Other insurance considerations

While the missing tooth clause is often the most discussed, it is not the only limitation to consider. Some policies have waiting periods for services. Waiting periods for restorative services such as fillings are generally six months while waiting periods for major services are usually up to a year. Insurance companies do not pay for the treatments when the waiting periods are in effect.

Preventative frequencies are also added to most insurance policies. This provision stipulates the number of times patients can go to the dentist to get regular cleanings. Most plans have preventative frequencies in place for twice a year or every six months. While both options allow patient to get cleanings two times a year, those who are limited to visits every six months must ensure the visits are not any closer. Going one or two days earlier can cause the claim to be denied.

Avoid the missing tooth clause and other provisions

If your insurance has a missing tooth clause, you can shop around for another policy. Read the fine print so that you are not surprised by any of the clauses. Consider the waiting periods and the preventive frequencies. After you find the right policy, purchase it and use it at your dental appointments. You can even use some policies to cover the replacement for a tooth you lost before the policy took effect.

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