Are Veneers Covered by Delta Dental Insurance? The Unvarnished Truth

Generally speaking, Delta Dental insurance typically does not cover veneers because they are usually classified as cosmetic procedures. However, as with all things insurance-related, the devil is in the details. Let’s delve into the nuances and explore the circumstances where you might find some assistance with the cost.

Understanding Delta Dental Coverage and Veneers

Navigating dental insurance policies can feel like deciphering an ancient scroll. Before we dive deeper, it’s crucial to understand how Delta Dental generally categorizes dental procedures. Delta Dental plans, like most dental insurers, categorize procedures into three main categories:

• Preventive: This includes routine cleanings, exams, and X-rays. These are usually covered at a high percentage (often 100%).
• Basic: This encompasses procedures like fillings, simple extractions, and root canals. These are typically covered at a moderate percentage (around 80%).
• Major: This category includes more complex procedures such as crowns, bridges, and dentures. Coverage percentages are usually lower (around 50%).

Veneers, unfortunately, typically fall outside of these categories because they are considered cosmetic dentistry. Cosmetic procedures are generally aimed at improving the appearance of teeth rather than addressing functional or health-related issues.

Why Veneers Are Usually Considered Cosmetic

Veneers are thin, custom-made shells (usually made of porcelain or composite resin) that are bonded to the front surface of teeth. They can improve the appearance of teeth that are:

• Discolored
• Chipped
• Cracked
• Misaligned
• Unevenly spaced

While veneers can offer some functional benefits in certain situations (which we’ll discuss later), their primary purpose is aesthetic enhancement. That’s why insurance companies, including Delta Dental, often exclude them from coverage.

Possible Exceptions: When Delta Dental Might Offer Some Coverage

Despite the general rule, there are specific circumstances where you might receive some coverage from Delta Dental for veneers, or at least for a portion of the associated costs. These situations are rare and typically require strong supporting documentation. Here are a few possibilities:

• Medically Necessary Veneers: If veneers are deemed medically necessary to restore function due to trauma, disease, or congenital defects, your Delta Dental plan might offer partial coverage. For example, if a significant portion of a tooth is lost due to an accident and a veneer is the most appropriate way to restore its function and prevent further damage, your dentist can submit documentation to Delta Dental explaining the medical necessity.
• Pre-Existing Conditions Clause: Some older policies might not specifically exclude veneers. Review your plan document thoroughly. It’s a long shot, but it’s worth checking.
• Negotiating with Delta Dental: Sometimes, dentists can negotiate with Delta Dental on your behalf, particularly if there are extenuating circumstances. Your dentist may be able to frame the procedure in a way that highlights the functional benefits alongside the cosmetic ones. This is more likely to be successful if you have a long-standing relationship with your dentist and they have a good track record with Delta Dental.

What to Do If Your Claim Is Denied

If your initial claim for veneer coverage is denied, don’t lose hope. You have the right to appeal the decision. This process typically involves:

• Reviewing the Denial Letter: Understand the specific reason for the denial.
• Gathering Supporting Documentation: Obtain a detailed letter from your dentist explaining the medical necessity of the veneers, along with any relevant X-rays or photographs.
• Submitting an Appeal: Follow the instructions provided in the denial letter for submitting an appeal. Be clear, concise, and persistent in your appeal.

FAQs About Delta Dental and Veneer Coverage

Here are some frequently asked questions to further clarify the complexities surrounding Delta Dental coverage and veneers:

1. What specific language in my Delta Dental policy should I look for regarding veneers?

Look for terms like “cosmetic dentistry exclusions,” “elective procedures,” and “non-covered services.” Specifically, search the term “veneers.” Review the section that details what your plan doesn’t cover. These sections clearly outline the procedures excluded from coverage.

2. If a veneer is needed after a car accident, will Delta Dental cover it under my medical or dental plan?

In cases involving car accidents, your auto insurance is often the primary payer for dental work required as a result of the accident. Your medical insurance might also play a role. Delta Dental would typically be secondary, if involved at all.

3. Can I use my Flexible Spending Account (FSA) or Health Savings Account (HSA) to pay for veneers?

Yes, you can typically use funds from your FSA or HSA to pay for veneers, regardless of whether Delta Dental covers them. These accounts are designed to cover qualified medical and dental expenses, and cosmetic procedures are generally eligible.

4. Does Delta Dental offer payment plans or financing options for procedures not covered by insurance?

Delta Dental itself typically does not offer direct payment plans or financing. However, many dental offices offer in-house payment plans or work with third-party financing companies like CareCredit to help patients manage the cost of uncovered procedures.

5. What alternatives to veneers might be covered by Delta Dental?

Consider these alternatives:

• Teeth Whitening: For discoloration, teeth whitening is often covered, at least partially.
• Dental Bonding: For minor chips or cracks, dental bonding (using composite resin) might be a more affordable and potentially covered option.
• Orthodontic Treatment: For misalignment, braces or clear aligners might be covered, depending on your plan.

6. How can I verify my specific Delta Dental plan’s coverage for veneers?

The best way to verify coverage is to contact Delta Dental directly. You can call their customer service line or log in to your account on their website. Provide them with the procedure code for veneers (typically D2962 for porcelain veneers) and ask them to confirm whether it’s covered under your specific plan. You should also request a pre-treatment estimate from your dentist. The pre-treatment estimate can be submitted to Delta Dental to get an official coverage determination.

7. Are there any Delta Dental plans that are more likely to cover cosmetic procedures?

Generally, no. Delta Dental plans are fairly consistent in their exclusion of cosmetic procedures. However, some higher-premium plans might offer slightly better overall coverage, potentially leading to small savings on the overall cost of veneers through other covered services.

8. If I have two Delta Dental insurance plans, will that increase my chances of getting veneers covered?

While having two dental insurance plans can sometimes provide additional coverage, it’s unlikely to change the outcome regarding veneers. The coordination of benefits between the two plans will likely still result in veneers being classified as cosmetic and therefore not covered.

9. What questions should I ask my dentist before getting veneers?

Ask these crucial questions:

• “What are the long-term costs associated with veneers, including maintenance and potential replacements?”
• “What are the potential risks and complications associated with veneers?”
• “Are there any alternatives to veneers that might be more cost-effective or covered by my insurance?”
• “Can you help me submit a pre-treatment estimate to Delta Dental to determine coverage?”

10. Is it worth getting veneers even if they are not covered by insurance?

That depends on your individual circumstances and priorities. Consider the cost, the potential benefits (both aesthetic and functional), and your overall budget. Compare the cost of veneers to the costs of alternatives. It’s a large investment, but it may be worth it if it significantly improves your confidence and quality of life.

11. Can my dentist bill Delta Dental for a portion of the veneer procedure, even if it’s considered cosmetic?

In some cases, a dentist might be able to bill Delta Dental for a portion of the veneer procedure if it involves addressing an underlying dental issue, such as repairing a significantly damaged tooth. However, this is often a gray area, and the success of this approach depends on the specific circumstances and the dentist’s ability to justify the medical necessity.

12. What if my employer offers Delta Dental insurance? Can I negotiate for better veneer coverage through my employer?

While it’s unlikely that you can directly negotiate for better veneer coverage, you can certainly suggest that your employer explore different Delta Dental plan options that might offer more comprehensive coverage overall. However, keep in mind that even the most comprehensive plans are unlikely to cover purely cosmetic procedures like veneers.

In conclusion, while the path to Delta Dental coverage for veneers is typically blocked by the “cosmetic” designation, understanding the exceptions and exploring all available avenues is crucial. Armed with information and a proactive approach, you can make informed decisions about your dental health and finances.