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Dental Insurance Healthcare – What is a Missing Tooth Clause.

Monday, Mar. 28th 2022 6:20 AM

Over the coarse of ten years and bad teeth care habits I have lost a few teeth. I never had dental insurance and did not go to the dentist because I do not like dentists. Now I am currently paying the price for having such a bad attitude about my oral health care and dentist.I am trying now to do the right thing and get my teeth fixed up but I am finding out that there are no dental insurance plans willing to help me.

Many of the dental insurance plans I see have long term waiting period for the dental services I know I will be needing to have. If I have no choice in the matter I may be willing to wait out the waiting periods but I was told that many dental insurance have missing tooth clause and it may not be worth my buying dental insurance since the plan will not cover the dental work I would need to fix my teeth.

Reply: That is correct that there are many dental insurance plans that have a missing tooth clause. Example below:

  • services for congenital (hereditary) or developmental (following birth) malformations, including but not limited to cleft palate, upper and lower jaw malformations, enamel hypoplasia (lack of development), fluorosis (a type of discoloration of the teeth) and anodontia (congenitally missing teeth), except those services provided to newborn children for cleft lip or cleft palate.
  • Cosmetic surgery or procedures for purely cosmetic reasons, or services for congenital (hereditary) or developmental malformations. Such malformations include, but are not limited to cleft palate, upper and
    lower jaw malformations, enamel hypoplasia (lack of development), fluorosis (a type of discoloration of the teeth) and anodontia (congenitally missing teeth).

It is important to read each dental insurance exclusions ( What the Insurance Company does not pay Benefits for)

It seems as if however you are reviewing mostly PPO’s dental insurance plans. You may find that HMO plans do not have such limitations. However still be mindful of their exclusions as some will limits that may still effect the benefits your may want to have.

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