How do you fight it when an insurance company refuses to pay for something because it is "cosmetic"?

I was born without four permanent teeth and there are no insurance companies that will cover the implant surgery or even a less functional option of replacement because they say it is "cosmetic." I feel like there is an obvious difference between REPLACING teeth and implanting teeth I never had. Can this be addressed through an appeal and is there really even a chance they will change their minds? I really don't know much about insurance companies and how these things work. thanks.

How do you fight it when an insurance company refuses to pay for something because it is "cosmetic"?
The odds of getting dental implants covered by a health insurance company are slim and none. Most health insurance policies exclude dental work of any kind, except in very limited circumstances. I'd be incredibly surprised if you got coverage for these dental implants through a health insurance policy.





As far as dental insurance goes - I'm not that much more optimistic about those odds either. Many dental policies specifically exclude implants. If you want to find out for sure what criteria they use to determine coverage for implants, they should be able to provide you with a copy in writing. (Either the full details of your own policy, listing any exclusions that might be in place for implants. Or a copy of the criteria used to make the decision whether implants are cosmetic or necessary.)





As I said, I'm not overly optimistic about your chances. But you certainly have the right to request the written policy and discuss it with your dental provider.
Reply:The only chance you might have to to get your dentist to state in writing that the procedure is necessary for your health.
Reply:look in the contract for anything about pre existing conditions. but people do put braces on purely for cosmetic issues. I'm watching this one. gl
Reply:It's gong to be an uphill battle to say the teeth are a medical necessity. You have lived this long with out them. Are you unable to eat w/o them?





Unless the Dr can convince the insurance company that it is a medical necessity - they are not going to pay for it.
Reply:Read your policy, there are probably exclusions for cosmetic procedures, so unless this is compromising your health the insurance company does not have to cover the procedure.





Another option if you want this procedure done is to look at discount programs. They are not insurance, but they can help you save a good chunk of money on the procedure as long as your dentist accepts the discount program. The Caring ton network is pretty large and has a good discount ration with their dental discounts.
Reply:Health insurance companies don't cover dental issues, so you're likely going to get a denial for TWO reasons, one is cosmetic, other is, well, it's HEALTH insurance.





Sure you're welcome to appeal, I seriously doubt you'll ever win.





I don't know how much the implants cost - but I can't imagine a bridge being more than a couple thousand, and maybe a heck of a lot less. That's a part time job, for two months.





It's not out of your reach to just work a little bit more, and pay for it out of pocket. If it was that important to ME, that's what I'd do.



C#