Coverage of a dental procedure

[Guest helenw]

There is a participant in an employer's cafeteria plan who is being denied coverage for what I think is a covered expense and I need some other opinions or even a place to go to get the answer.

The participant took tetracycline as a teenager that turned her teeth black. So many years ago she had veneers put on her teeth to correct this problem. Well last year the veneers started to break and crack. She went to the dentist who said the only solution was to put new veneers on or cap the teeth since they had already been ground down for the first set of veneers. He recommended the caps and so the participant waited until this year and just had the caps put on.

The employer is stating that the guidelines for cafeterias are very clear that teeth whitening is not covered but since her teeth had already been ground down replacing the damage veneers with new caps is not teeth whitening. Any input on this would be appreciated.

[Guest MSMA]

I would ask that the dentist supply a letter of medical necessity stating that the veneers are not cosmetic and what medical condition this treatment would alleviate.

[mbozek]

Deductible medical expenses under IRS Pub 502 includes fees paid to dentists for fillings extractions, dentures, etc. Caps are are deductible expense. A cap which is necessitated by a breakdown in the veneer is not just cosmetic- it is necessary to protect the tooth from further decay.

[Guest JerseyGirl]

Many years ago, I worked as a Dental Assistant for a very well-respected specialist in crown & bridge. I saw this dentist convince insurance companies time and again of the necessity of full-mouth restoration. In some cases, the patient had so few natural teeth left that it was his opinion digestive problems would eventually develop, and he would instruct the patient to see their MD and request a letter to the insurance company to back up the dentist's opinion. This dentist would then write his own letter to the insurance carrier, and send in the two letters together to get pre-approval of the restorations.

The key phrase is: restoring full form & function to the dentition.

Logically speaking, this poor woman should not be expected to spend the rest of her life with exposed ground-down teeth. In order to *restore full form and function* to her mouth,she needs to have her veneers replaced,either by new veneers or crowns. I believe this is a very eligible expense. However, if this participant has dental coverage, she may want to try this tactic with the insurance carrier first.