When dental care is covered by the health plan

My one-year-old daughter was diagnosed with dentinogenesis imperfecta; her teeth will be weak, soft, and discolored.  Treatment will have to be done for her baby teeth and her adult teeth.  We don’t have a dental plan.  Is it possible that our medical plan would pay for this?

Thin Smile

Dear Thin Smile,

Yes, it is possible but you might have to fight for it.  Treatment of dentinogenesis imperfecta consists of applying enamel to the teeth, a service provided by dentists. Though dental services are not generally covered by medical insurance, you could request your plan to consider covering it. Your rationale will be that the condition is genetic, has a broad impact on her overall health, and the treatment is not cosmetic. Your dentist will be the point person for arguing your case to the health plan.

If they refuse, you can appeal the decision and have an outside party review your case. Good luck!

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.