Unfortunately, delta dental does NOT cover veneers, or at least we've never seen it covered on any of our patients, which means there's 0% coverage and you're responsible for 100% of the cost.
However, we have come across a benefit summary of one of our patients which may potentially have porcelain veneer coverage. Although it seems like it has a chock full of limitations that are ready to exclude you benefits.
Nonetheless, let's dive into the details of what we mean but we should first start with the billing code for this procedure. That is so we're all on the same page about what we're talking about.
Dental code for veneers
A dental veneer or porcelain laminate fabricated by a dental lab uses the dental code D2962. It is a thin piece of porcelain that is placed over the front half of your tooth and it's purpose is for cosmetic reasons.
Reasons to get veneers:
Change the shape of your tooth.
Alter the color of your teeth.
Any other reasons for "improving" your smile.
Vs crowns
Veneers are different than crowns in that they are more conservative. A dental crown requires preparing or shaving the entire tooth 360 degrees while a porcelain laminate only requires 180 degrees of preparation.
Since they are completely different types of restorations, a crown uses the dental code D2740 or D2750 instead of D2962. That is done to differentiate the two types of treatments.
However, what remains the same for both of them is that they are indirect restorations which are fabricated by a dental lab. They can be both made of ceramic and porcelain.
Delta dental coverage for veneers
On average, the coverage for a veneer with delta dental insurance is 0% which means there is no coverage for this treatment. In other words, you'll be responsible for paying the entire treatment cost with no help from your insurance.
Below is an example of a typical benefits breakdown for this procedure from one of our patients. It shows as you guessed, 0% coverage which is what we see on average with delta plans.
Most of the time whenever, we search for benefits for procedure code D2962, the above is what is returned. However, that doesn't mean it isn't possible to have coverage for your cosmetic laminate procedure because we've seen otherwise.
Potential coverage
To prove our point, below is an example of one of our patients who may have potential coverage. The benefits breakdown shows them as having 50% coverage for veneers.
However, you need to be extremely wary of the amount of limitations which are listed. Delta dental lists a egregious amount of limitations which can exclude you from having coverage.
Listed limitations:
Clinical need subject to professional determination.
Pre-treatment estimates are encouraged.
Tooth cannot have had a restoration placed within last 12 months.
Tooth cannot have had a crown, bridge, onlay, inlay, or other restoration within the last 5 years.
5 year limitation if you already had a veneer on it.
That is a mouthful of restrictions and stipulations to getting approved for this procedure.
Why we say that is a lot of limitations
That is a LOT of limitations because if you compare it to crown benefits, the crown has only one limitation.
The image above shows what the benefits and limitations say for a single crown. Can you see the difference in the wording? You can probably guess the intention behind delta in regards to crowns vs veneers right?
In case you were wondering, yes delta dental does have coverage for crowns and they cover it much more readily.
Cost of veneers with delta dental
The average cost of a veneer is $1328.04 with delta dental and that is with zero coverage. Since it doesn't cover the procedure, the average cost would be what your dentist's typical private UCR fees would be.
The table below shows the national average as well as the range of fees based on the ADA survey of fees. These numbers are based on dentist offices who responded to the survey so it is not 100% inclusive of every office in the US.
Statistics | Cost |
|---|---|
Average cost | $1328.04 |
10th percentile cost | $1000 |
90th percentile cost | $1795 |
The average fee of $1328.04 is a good ball park figure to work with. However, it can be significantly more than the listed 90th percentile cost if you go to a super luxurious dental office that caters to celebrities.
Ultimately, what you can expect to pay would be determined by the cost of living in your neighborhood. Are you in a high cost of living area or a low cost of living one? Use your judgement and adjust the figures to your personal situation.
Why don't insurances cover veneers?
The main reason why dental insurances don't cover veneers is because they're a cosmetic procedure. This rule applies to ALL of the dental insurance carriers and is not limited nor specific to delta dental. All of the carriers seem to hold the same point of view.
The purpose of insurance in general is to fix a problem when something goes wrong. If you don't like the shape of your tooth or its color, there isn't actually something wrong with it. That tooth is still fully functional, you can eat with it and speak with it just fine. The only thing that is wrong is your perception of it.
Insurances will not pay for procedures and treatments that aren't "necessary". This applies to every type of insurance such as health insurance and even auto insurance.
Does your health insurance pay for your plastic surgery to get a tummy tuck?
Does your car insurance pay for a new paint job just because you want to change the color?
The answer is no to the above two questions. Your car insurance will only pay for repairs if you get into an accident. If the car is still functional and otherwise nothing wrong with it, you will not get any help from the insurance. Your dental insurance works in exactly the same way.
Takeaway
While it isn't impossible to get veneer coverage with delta dental, it is unlikely based on our experience. To be quite honest, we've received so many denials from submitting porcelain laminate pre-approvals that we literally stopped sending them. We do still submit them occasionally when our patient insists on checking.
We've yet to see an approval but if you do manage to get one, we will applaud you for it. You should definitely take advantage of it and get it done because your next insurance may not cover it!
Key points:
Most likely, there will be zero coverage for it.
The average cost with no coverage is $1328.04
The primary reason for insurances to deny veneers is due to them being for cosmetic purposes.
Despite the less than stellar news, it doesn't mean that you shouldn't get veneers if you want or need them. If you believe it will truly improve the quality of your life, please discuss with your dentist about how to afford or finance them.
