When our car windshield gets a crack, does our car insurance policy say, “No coverage until it breaks in half or until it shatters?†Does your medical coverage say, “No coverage on a fractured bone until it breaks all the way through?â€
Of course not. We all understand that the situation can become much worse if we let fractures expand. However, many dental insurance companies eliminate coverage for restorations that are designed to make a broken tooth strong again. Why? And why is it an important issue to you?
Why do insurance companies have an elimination clause on fractures and wear?
- Many broken teeth have relatively small fillings or none at all. So, from looking only at an x-ray that doesn’t show the crack, it can look like over-treatment. (That is why we also send photos, but even that does not usually help)
- There may not be pressing painful symptoms at the time.
- Broken teeth may take several years to split or need a root canal treatment.
Also, insurance companies “bet†that you will be gone before the problem becomes a crisis. They know the average subscriber will be on a different plan in two years, which means another company will have to pay. Insurance companies eliminate benefits on fracturing and heavily worn teeth as a short term strategy to get cash flow savings.
We wish we could predict exactly when teeth will fracture away, need a root canal treatment, or be lost due to splitting in half. We do know that timely, adequate treatment most often prevents bigger problems later. The next post will describe the risks of not investing in early preservation of your teeth.