Getting medical insurance to cover dental procedures.

March 8, 2009 6:16 PM

Getting medical insurance to cover dental procedures.

I have a somewhat rare medical condition, amelogenesis imperfecta, meaning I was born with no enamel on my teeth. This has required a lot of dental work over the years. I have temporary crowns that are 15ish years old and need to be replaced with permanent crowns ASAP. This is going to be very expensive and my dental insurances really do not cover much at all (maybe 1-2 teeth/year).

My dentist suggested looking into getting my medical insurance to cover them since I have a medical condition. Surely he suggested this because he has seen someone do this successfully before. I was wondering if anyone here had been able to get medical insurance to cover dental work and if so how they went about it. Any advice appreciated.

posted by disaster77 to health & fitness (4 comments total)

I've had luck with medical insurance paying out for accident-related fixes (implant placement, extractions, etc.). I could see this working albeit with some convincing: all the successes I had required at least one follow-up call on the part of my surgeon or dentist after an initial denial.
posted by kcm at 6:18 PM on March 8

Generic advice for making phone calls to mega-bureaucracies: If the person you are speaking to does not seem to "get" what you are talking about, just hang-up and call back until you get someone who is at least on the same page as you. You may ultimately still get a "No," but at least you don't have to waste time explaining the concept to the person.
posted by Rock Steady at 6:30 PM on March 8

When I worked in a prosthodontic office, we were able to get appliances paid by medical insurance for conditions such as cleft palate and ectodermal dysplasia. These conditions, along with other deformities/abnormalities, present with missing teeth. So medical insurance paid for removable partial dentures, and/or implants to secure them.

Because amelogenesis imperfecta only involves teeth, it will be a harder argument to make to the medical insurance company. I don't have personal experience billing for something like that.

To the above advice I'd add, get your medical doctor on board by writing up the diagnosis, with the recommedation of having your teeth restored with the crown work. Dental offices who don't routinely do medical claims may not even know how to begin to submit to insurance, so you are going to have to do a lot of the work. If your medical does agree to pay for treatment, get a written preauthorization. They can deny treatment after first saying yes. Get names of anyone you spoke to on the phone, go back to a familiar person to follow up with any additional questions.
posted by Jazz Hands at 8:47 PM on March 8 [1 favorite has favorites]

If the insurance route fails, you might want to present to the nearest Dental School. AI is rare enough that you are likely to get a lot of the right kind of attention at lower cost.
posted by OHenryPacey at 12:25 AM on March 10