Teeth bleaching

[SLuskin]

We had denied a claim for teeth bleaching for the CFO of a good client. Now he is saying that this tooth is part of a root canal. Every few years the dentist takes off the cap, rebleaches the tooth and puts the cap back on. Does anyone consider this to be different from other types of teeth bleaching?

[leevena]

I have had two teeth that required root canal and caps. The original work was done some 35 years ago. Since then I needed to have the caps replaced (20 years ago) because of damage. That scenario was considered medically necessary. This scenario sounds more like cosmetic, unless there is proof to the contrary.

[LRDG]

If discoloration of teeth is a secondary condition to a primary medical condition or disorder, it may be eligible for reimbursement from FSA. But it may also be eligible under the major med plan if secondary treatments are covered.

For example, tooth/teeth disorders resulting as a side effect of chemotherapy treatment for cancer, teeth bleaching to correct discoloration resulting from a medically necessary treatment might be covered under the major medical plan, and co-pay would be reimursable from medical FSA. If not eligible under the major medical plan or dental insurance plan, bleaching treatment would be reimbursable 100% from the medical FSA.

I wouldn't deny every claim for teeth whitening without first making a determination if there is underlying medical necessity, which could include the original dental procedure.