Dental expenses reimbursable via Medical FSA

[Guest NSMITH]

Can someone please advise me on the following question about qualifying dental expense status under our Medical FSA:

Employee has chipped front tooth and there is a noticeable color difference between the exposed chipped tooth and the enamel of the other teeth. Employee would like to use her FSA to pay for "laser power bleaching" performed in dental office by Dentist in conjunction with the repair to the chipped tooth. This combination of procedures would ensure that the repair of the chipped tooth is unnoticeable in her smile. Is this dental expense reimbursable by FSA?

Thanks so much for your help!

[KIP KRAUS]

I would allow it. Even though it is cosmetic if it's on a facial tooth it should be covered.

[mroberts]

Sounds a lot different than just getting all your teeth bleached for the heck of it. As Kip pointed out, because it's a front tooth, it sounds good to me.

[Guest MSMA]

And just to confuse you...I would NOT pay it because it IS cosmetic. Bleaching does not satisfy the following: "Medical Care" expenses include amounts paid for the diagnosis, treatment, or prevention of disease, and for treatments affecting any part OR FUNCTION of the body.

...or as worded in the Thompsons Flex Plan Handbook: a doctor's certificate should be obtained explaining how the procedure meaningfully promotes the proper function of the body (see #322)

Bleaching teeth, whether laser or not, does not enhance the function of the person's teeth. It will only serve to improve that person's overall appearance.

Question? Would you allow tooth bleaching if someone's teeth were stained due to excessive tea drinking or tobacco use?

[mroberts]

Tobacco teeth would be a different set of cirumstances. I'm aware of the Flex regs that pertain to what is and what is not covered, however, I think this should be viewed differently.

For example, if you had a cavity in one of your teeth, dental plans standardly will only pay for a silver filling unless the cavity was in one of your front teeth. In this case, it would pay for a clear filling.

Additionally in this example, the employee probably did not decide to run to the nearest kitchen counter and slam her teeth into it hoping to chip one so she could use FSA dollars to pay for the eventually bleaching of this tooth. Everyone knows that smoking makes your teeth yellow. You can but over the counter stuff to mitigate that problem.

I would limit this laser bleaching stuff to the tooth or set of teeth in question, not the whole mouth.

[GBurns]

To repair the chipped tooth is covered. To make the newly repaired tooth match the others is covered. Why not regard the matching of all the teeth as part of the repair job.

I do not see why you would not regard the whole job if done at one time to be a single "repair" job and cover everything.

I equate this to doing body work on a car. If you had an accident and had to replace the right fender, the hood and 1 door, I am sure that you would find the color matching unacceptable and would want the whole car repainted so that the color was uniform.

If we can regard the appearance of a car as being that important, how can we give less value to a persons appearance that will be disrupted if a partial job is done. The employee is not just getting it "bleached" for vanity, they are just taking the opportunity created by the repair of the chipped tooth to correct the damage done by the irregular appearance that the repair itself will cause.

[mroberts]

I wouldn't cover the whole mouth getting bleached because it isn't necessary. If the price was going to be the same whether two or three teeth were done or whether 25 teeth were done, then I would say knock yourself out, however, I would find it hard to believe this would be the case. No one is going to pry the person's mouth open and compare the color of the front incisor to the back molar. What should be done is trying to blend the colors of the teeth that are in question.

As far as your example goes with the car, I've been in two accidents. When I just brought my car in for the most recent repairs, the claims examiner noticed that there was a slight difference in color between the trunk and back panel. Apparently the first time it was fixed, the color was slightly off and I didn't even notice it since it was probably buffed and waxed to seem perfect. He indicated that once the trunk was repaired I could pay the auto body repairman extra to get it blended so that the difference wouldn't be noticeable.

[Guest SheilaLuken]

I would think that the provision in sec. 213 about cosmetic surgery being allowed to "ameliorate a deformity arising from...a personal injury resulting from an accident or trauma..." would apply in this situation.

[Guest RAJ]

I would agree with Sheila. It seems the initial reason for the bleaching is related to a medical condition or correction of a deformity and not for cosmetic purposes.

[Guest MSMA]

Okay - okay....you've persuaded me to change my original opinion.

But - I would still probably ask for the statement from the physician just to document the file.

This exchange has reminded me just how valuable a tool this bulletin board can be. As you well know, we often run into "grey" areas within the 125 program - and feedback / input from others such as yourself is greatly appreciated.

Have a good weekend everybody!

[Guest RAJ]

MSMA: I think obtaining more detailed information from the doctor is also a good idea. Sort of a "CYB" based on the decision to reimburse.

I also agree with you on the message board. The variety of opinions expressed has aided me in a number of determinations. With all the grey areas, it is difficult for one person to obtain all possible angles. Hats off to the message board participants!!!

[Guest brobinso]

OK, I have a claim for teeth bleaching. Dentist's letter states that the participant has tetracycline staining on the teeth.

So... the staining is a result of the treatment of a disease...the bleaching is due to the staining...

Would you consider this teeth bleaching a reimbursable expense?

I could argue:

it's cosmetic - bleaching is done due to stains, there is no disease, injury, or deformity to the teeth

it's medical - the bleaching is done due to staining which arose due to disease elsewhere in the body

What's your call?

[Guest MSMA]

cosmetic

It does not improve or aid in the function of the teeth

[Guest RAJ]

I looked up tetracycline on the internet and it is a medication that treats a specific form of bacteria. Under the cautions of the medication, it indicates that a side effect may be permanent discoloration of teeth, especially when used for children.

This is a tough call, because I suppose you could stretch and say it was indirectly caused by the treatment of a medical condition. Initially I was leaning towards cosmetic.

Hope this helps and let us know what the outcome is.

[Guest Factster]

Can't say that I agree with the statement that the "initial reason for the bleaching is related to a medical condition or correction of a deformity and not for cosmetic purposes."

The deformity existed with the chipped tooth, not with the other discolored teeth. The tooth is fixed and now it is white, while the others are dark. While the dark teeth may not be pleasant to look at, they are not a deformity, they are a disformity. The decision to bleach is a result of cosmetic preference, not medical necessity.

[Guest brobinso]

FYI - I disallowed the claim as cosmetic.

[Guest brobinso]

What about teeth bleaching due to decalcification? Fluorosis?

Although the EBIA legal guide says teeth whitening may be reimbursable "if tooth discoloration was caused by disease, birth defect or injury," I am having trouble determining what constitutes a dental "disease."

I guess I should make the participant's dentist define whether the condition is a "disease" or not?