Dental Insurance: Is It Time to Challenge the Exclusion?
I’ve been experiencing jaw clenching and teeth grinding at night, which has led to some noticeable wear on my teeth. My dentist even discovered a small chip on one of my back teeth, likely caused by this issue. Unfortunately, my dental insurance has a specific exclusion for night guards. However, considering that not addressing this could lead to higher costs for both them and me down the line (with a night guard priced at $750), is there any way to persuade them that covering this expense would ultimately save everyone money on future dental repairs? Or is that a long shot?
It sounds like you’re dealing with a frustrating situation. While many dental insurance plans do exclude night guards, there may be some strategies you can try to persuade your insurance provider to reconsider.
Documentation from Your Dentist: Ask your dentist to provide a detailed letter explaining your condition, the potential future dental issues caused by grinding and clenching, and how a night guard could help prevent those problems. A thorough explanation may strengthen your case.
Medical Necessity: Emphasize that the night guard is a medical necessity for you. If your dentist can provide a diagnosis related to bruxism, this might help your case. Some insurance companies are more likely to cover appliances if they can justify them as medically necessary.
Historic Claims: If you’ve had dental work that was the direct result of clenching and grinding in the past, gather records of those claims to support your argument that a night guard may help prevent future costs associated with these issues.
Appeal Process: If your initial claim for coverage is denied, don’t hesitate to initiate the appeal process. Many people have had success in overturning exclusions after formally appealing through their insurance company’s process.
Switching Plans: If this is an ongoing issue, you might want to look at other insurance plans when your renewal comes up. Some plans offer better coverage for appliances like night guards.
Ultimately, while getting insurance to cover a night guard can be challenging, providing documentation and highlighting the long-term cost-saving benefits could make a compelling case. Good luck!