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.

Request an appointment here: https://familychoicedentistry.com or call Family Choice Dental at (505) 634-5657 for an appointment in our Albuquerque office.

Check out what others are saying about our services on Yelp: Read our Yelp reviews.

Recent Posts

Bridges Vs. Dental Implants: Which Is Better

When someone is missing teeth, a couple of replacement options include bridges and dental implants. These are common ways to fill in the gaps, but there are differences between the two. Each has its advantages and disadvantages, and it is important to understand them before making a decision.A bridge is anchored by the teeth on…

Oral Hygiene Basics: The Importance Of Cleaning Your Tongue

Brushing and flossing are essential oral hygiene basics that help prevent tooth decay and gum disease. While many people pay careful attention to their teeth and gums, the tongue is often neglected. However, this large surface of the mouth should also be cleaned on a daily basis. Doing so can help many people enjoy better…

Types Of Dental Implants

A patient may invest in dental implants for a variety of different reasons, many of which focus on positively changing personal image and improving overall oral health. Implants are often applied when patients are missing one or more teeth and are not interested (or have had no success with) dentures or dental bridges. To understand…

Why Dental Implants Are Good For Your Health

When it comes to tooth replacement options, you have several, one of which is dental implants. Dental implants are an advanced tooth replacement option that comes with several benefits. In addition to improving the aesthetics of your smile, implants can help to improve the functionality of your mouth. They feel and work virtually identically to…

Recent Posts

Bridges Vs  Dental Implants: Which Is Better

Bridges Vs. Dental Implants: Which Is Better

When someone is missing teeth, a couple of replacement options include bridges and dental implants. These are common ways to fill in the gaps, but there are differences between the two. Each has its advantages and disadvantages, and it is important to understand them before making a decision.A bridge is anchored by the teeth on…

Oral Hygiene Basics: The Importance Of Cleaning Your Tongue

Oral Hygiene Basics: The Importance Of Cleaning Your Tongue

Brushing and flossing are essential oral hygiene basics that help prevent tooth decay and gum disease. While many people pay careful attention to their teeth and gums, the tongue is often neglected. However, this large surface of the mouth should also be cleaned on a daily basis. Doing so can help many people enjoy better…