What is the missing tooth clause for Aetna?
Asked by: Mariela Donnelly | Last update: March 23, 2025Score: 4.8/5 (69 votes)
Does Aetna dental have a missing tooth clause?
Aetna's dental insurance plans may carry a missing tooth clause. A missing tooth clause allows insurance plans to deny coverage costs for teeth replacements that were missing before the policy's implementation. However, under certain conditions, you may be able to request the removal of this clause.
What is the missing tooth clause on a dental plan?
What is the missing tooth clause in dental insurance? The missing tooth clause is a clause in the dental insurance plan that will not cover any dental treatment that replaces a tooth that was extracted or missing prior to the date the insurance coverage started.
What is the Guardian Missing tooth clause?
If your Guardian PPO Dental insurance contains a missing tooth clause, any tooth that was lost before the insurance coverage start date would not be covered. The full denture, partial denture, implant, or bridge needed to replace the tooth or teeth would have a 100% out of pocket cost to you.
What is missing tooth clause denial?
Your claim won't go ahead in the presence of this clause if you want to replace a missing tooth. The dental specialist may resubmit it, but they will face rejection every time. The insurance company will deny it due to a missing tooth clause.
Significance of the Missing Tooth Clause in Dental Insurance
What is the principal missing tooth clause?
The missing tooth clause in dental insurance policies states that the insurance company will not cover the replacement of any missing tooth or teeth that occurred prior to the start date of the policy. In other words, if you currently have a missing tooth, that missing tooth is a pre-existing condition.
Can a dentist refuse your insurance?
Out-of-network dentists refuse to allow insurance companies to dictate how they will treat their patients. They choose not to sign up with insurance companies because they do not want the restrictions that in-network dentists must conform to. Out-of-network dentists are free to do what is best for the patient.
What is the best insurance to have for dental?
- Best Overall and Best for Braces, Implants, and Older Adults: Delta Dental.
- Best Overall Cost-to-Value: Physicians Mutual.
- Best for No Annual Maximum: MetLife.
- Best for No Waiting Period: Anthem Blue Cross Blue Shield.
- Best for Customer Satisfaction: DentaQuest.
Is a missing tooth a pre-existing condition?
Most dental insurance companies will not pay your claims if you were missing a tooth prior to enrolling with them. But, that's just one “pre-existing” condition they won't cover. If you had the misfortune of chipping or cracking a tooth before signing up, your coverage to fix those issues will stop there.
How do I submit a dental claim to the Guardian?
- Log into Guardian Anytime.
- Select Contact us/Secure channel (located in the page footer).
- Fill in all required information.
- Attach the completed claim form and other documents to upload.
- Click Submit.
Will insurance pay for missing teeth?
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.
How do I fight dental insurance denial?
A proper appeal involves sending the carrier a written request to reconsider the claim. Additional documentation should be included to give the carrier a clearer picture of why you recommended the treatment and why you feel the claim should be reconsidered.
What is the ADA missing tooth clause?
As a rule, when it applies, any tooth missing or extracted prior to the current plan's effective date will not be covered. In other words, the patient must have had the same insurance carrier when the tooth was extracted. Certain plans do have special provisions allowing for coverage.
What is the missing tooth clause in a dental plan?
A missing tooth clause is a contractual provision in a dental insurance plan whereby the insurance company candeny coverage for the cost of the tooth replacement procedure if the tooth was lost, extracted or removed before the patient's coverage takes effect. This clause may also apply to a congenitally missing tooth.
Does Aetna pay for tooth implants?
One major factor that can determine if your dental implants are covered by an Aetna Medicare Advantage plan is whether the implants are considered cosmetic or medically necessary. If cosmetic, some plans might not cover the implants. But if the dental implants are considered medically necessary, they may be covered.
What is the dental diagnosis for missing teeth?
Hypodontia refers to the absence of fewer than 6 teeth (not including third molars). Oligodontia refers to the absence of 6 or more teeth (not including third molars). Anodontia is the complete absence of teeth. Hypodontia is more common in the permanent dentition than in the primary dentition.
Does dental insurance pay for pre-existing conditions?
Pre-existing conditions: Most dental plans exclude coverage for dental conditions that already existed at the time of enrollment. For example, many policies won't cover missing teeth. But pre-existing conditions don't include dental conditions you weren't aware of, such as cavities.
Can you get dental implants if your teeth have been missing for years?
Yes, you can! It is never too late for dental implants, although you may have to undergo additional procedures such as a sinus lift. One out of every two adults age 20-64 is missing at least one permanent tooth. Primary causes are cavities, periodontal diseases, injury, and lack of consistent oral care.
How can I fix my teeth if I don't have money?
- Nonprofit clinics. Some cities have dental clinics that specifically serve people with low incomes, no insurance, or who otherwise can't afford care.
- Donated services. Some state or national charities use donated labor and materials to give free care. ...
- Private dentists.
Why is dental work so expensive even with insurance?
Overhead costs for dental practices, which can account for 60% to 80% of patient charges, include many expenses such as rent, payroll, insurance, taxes, supplies, and advanced technology. The repayment of student loans from dental schools also plays a role in the overall costs.
What does dental insurance not cover?
Many plans do not cover elective services or procedures deemed cosmetic in nature. This means that treatments like teeth whitening or veneers may not be covered under your dental insurance policy.
What to do if you need to go to the dentist but have no insurance?
Free or Government Clinics
You could also look online to see if any government clinics are offering dental services for free near you. Many dentists and dental professionals volunteer throughout the year to provide their services at no cost to those in need.
Why are so many dentists dropping insurance?
The Problem With Dental Insurance Companies
Insurance-based dentistry tends to prioritize functional outcomes over esthetic considerations, leading to compromises in the quality of care provided. For many dentists committed to delivering superior results, this misalignment becomes increasingly apparent over time.