Dental veneers, thin shells made of porcelain or composite materials that are attached to the front of the natural teeth, have become increasingly popular for people looking to improve their smile. Their ability to correct problems such as discoloration, minor misalignments or chips makes them a sought-after cosmetic dental dentistry procedure.
But as with many dental treatments, especially cosmetic dental ones, understanding insurance coverage for composite veneers can be challenging. This guide aims to provide clarity about this. We discuss how and when porcelain veneers are covered by dental insurance and provide insight for those without insurance, as well as medical billers and practitioners who want to help their patients get reimbursed for their veneers.
When are Veneers Covered by Dental Insurance?
Since veneers are often considered a cosmetic dentistry procedure, insurance coverage can sometimes be a gray area. Here’s a deeper dive into when dental porcelain veneers might be covered by dental insurance:
- Medical Necessity vs. Cosmetic dental Desire:
Cosmetic procedures: Most dental insurance company policies categorize veneers under cosmetic procedures. If you are getting composite veneers only to improve the appearance of your smile (e.g.
Medical Necessity: There are cases where veneers may be considered medically necessary. For example, if a tooth is severely discolored due to trauma or medication, or if a tooth has lost significant structure and porcelain composite veneers are recommended to protect it from further damage, insurance may be more inclined to provide coverage.
- Pre-existing Conditions:
Some dental insurance plans contain clauses about conditions that existed before the policy began. If veneers were needed before your coverage began, insurance may not cover the veneer cost. However, as insurance policies and regulations evolve, exclusions related to pre-existing conditions are becoming less common in some regions.
- Inclusions and exclusions in your specific plan:
Dental Insurance plans vary widely in their coverage. While one plan may include veneers under specific circumstances, another may exclude them completely. It is essential to check the inclusions and exclusions of your policy or consult with an insurance company representative.
- Alternative Treatments:
Insurance companies can assess the need for composite veneers against other possible treatments. If there is a cheaper veneer procedure that produces the same medical result (for example, a crown or bonding), insurance may favor this treatment over veneers.
- Frequency Limitations:
Even if an insurance plan covers porcelain veneers due to medical necessity, there may be limitations on how often they provide this coverage. For example, if you have had a veneer on a particular tooth within a certain period of time, insurance may not cover a replacement for several years.
- Deductibles, copays and maximums:
If veneers are covered by your plan, you still need to consider the financial structure of the policy. You may have to pay a deductible before insurance starts paying, or there may be a deductible for the veneer procedure. Additionally, all dental insurance cover veneers and their dental insurance plans have an annual maximum amount they will pay, and the veneer cost of porcelain veneers can quickly approach or exceed these limits.
- Prior consent requirements:
Some dental insurance plans require prior authorization before undergoing specific veneer dental procedures. If you believe your veneers are medically necessary and therefore may be covered, it is a good idea to seek prior approval to avoid unexpected veneer costs.
It is imperative to maintain open communication with both your dentist and your insurer when considering veneers. If the dentist believes there is a strong medical reason for the veneer procedure, he may provide documentation or x-rays to the dental insurance company to support the claim. Always make sure you understand the terms of your policy and what veneer costs you may incur.
Are Out-of-Network Veneers Covered by Dental Insurance?
Coverage for veneers or other cosmetic procedures performed by an out-of-network dentist generally depends on your insurance plan:
HMO plans: Oral Health maintenance organization plans usually limit coverage to in-network dentists, meaning out-of-network procedures such as veneers are rarely covered.
PPO plans: Preferred provider organization plans may cover some out-of-network procedures.
Does Dental Insurance Offer Veneers Differently Depending on Your Plan?
Absolutely. Dental insurance policies differ in terms of terms, coverage levels and exclusions:
Different plans may have different definitions of what is “medically necessary,” which may affect whether veneers are covered.
The percentage of costs covered may vary. While one plan may cover 50% of the cost (in cases deemed medically necessary), another may cover 70% or none at all.
Some plans have waiting periods, especially for more expensive procedures, even if they are medically necessary.
How to find dental veneers that are covered by insurance
Navigating the world of dental insurance can be difficult, especially if you’re looking for coverage for specific treatments like veneers. Here is a detailed guide to help you research possible dental insurance coverage:
- Understand your needs:
Type of veneer: veneers come in different types, mainly porcelain and composite. Understand which one you need or which one you prefer as insurance may have different provisions for each.
Medical Necessity: If veneers are needed for medical reasons, such as repairing a damaged tooth, they are more likely to be covered than if they are for purely cosmetic reasons.
- Check your policy document:
The first step is to thoroughly review the summary of benefits of your current dental insurance. This document provides a detailed overview of which treatments and procedures are covered, and to what extent.
Look for sections related to “cosmetic procedures” or “restorative treatments.”
- Contact your insurance company:
Sometimes the direct approach is the best way to get clarity. Call your insurance company’s customer service department. This is usually stated on the back of your insurance card.
Ask them directly about their policy on veneers. Questions to consider include: Are veneers completely covered? Are there circumstances under which they are treated? How much is covered?
- Estimates for pretreatment:
Many dentists offer to send a pre-treatment estimate to your insurance company. This means that the dentist will outline the proposed treatment and the insurance company will respond with what they will cover and what your out-of-pocket costs may be.
This does not guarantee coverage, but it gives a clearer picture of the potential costs.
- Check for in-network versus out-of-network dentists:
Insurance plans usually have a list of in-network providers. You will often get better coverage if you use an in-network dentist.
If you are considering a dentist not covered by your plan, ask about out-of-network coverage. Coverage is usually lower and out-of-pocket costs higher, but it’s still worth checking.
- Discover alternative or additional insurance:
If your primary dental insurance does not cover veneers, you may want to consider purchasing additional cosmetic dental insurance. Some providers or plans specialize in offering coverage for cosmetic procedures.
- Read customer testimonials and forums:
Sometimes the best insights come from those who have walked the path before. Online forums, blogs, or customer testimonials can provide anecdotal evidence and tips about insurance companies known to cover dental procedures.
- Get multiple consultations:
If possible, consult multiple dental practices. Different dentists may have different experiences with insurance coverage for veneers. They may also have partnerships with specific insurance companies or offer their own financing or discounts.
- Periodic Updates and Policy Updates:
Insurance policies may change. Just because veneers aren’t covered by your current plan doesn’t mean they won’t be in the future. Stay tuned for policy updates or consider exploring new insurance options at renewal.
Finally, although dental procedures are often classified as a cosmetic procedure and are not always covered by standard dental insurance, there are options to possibly get some coverage or financial assistance. Being proactive, doing thorough research, and maintaining open communication with both your dentist and your insurance company are the keys to an effective process.
What to Do If You Can’t Afford Dental Veneers
If veneers are out of your financial reach, even with insurance, consider these options:
Payment plans: Many dentists offer financing options or payment plans to spread costs over time.
Alternative treatments: composite bonding or dental crowns can be cheaper and provide similar aesthetic results.
Dental schools: Some dental schools offer procedures, including veneers, at discounted rates as part of their training program.
Savings and budgeting: If veneers are essential to you, consider setting up a savings plan specifically for this purpose. Regularly setting aside money can make costs more manageable over time.
Finally, although dental procedures are primarily considered a cosmetic procedure by insurance companies, understanding the nuances of your specific insurance plan can help you evaluate potential coverage options. Always maintain open communication with both your insurer and your dentist so you can make informed decisions about your dental health and aesthetics.