Insurance Problems•3 min read

What Does 'Not Medically Necessary' Mean?

The Problem: The 'Optional' Label

Your dentist says you need a crown to save a cracked tooth. Your insurance denies the claim, saying it's 'not medically necessary' or that a large filling would suffice. Suddenly, your necessary medical treatment is labeled as a luxury or an option.

Why This Feels Invalidating

It feels dismissive. You're in pain or worried about losing a tooth, and a distant corporation is telling you it's not a big deal. It makes you question your dentist's integrity and your own judgment. You feel caught in the middle of a fight between two experts.

The Simple Truth: Definitions Differ

To an insurance company, 'medically necessary' often means 'the cheapest way to fix the immediate problem.' To a dentist, it means 'the best way to restore long-term health.' These are two very different standards. Insurance often downgrades care to the bare minimum, regardless of what is best for you.

What Should Happen Instead

You should focus on risk, not labels. Is the tooth at risk of breaking? Is the infection spreading? If the answer is yes, the treatment is necessary for *you*, regardless of what the insurance code says. You need to validate the clinical need independent of the financial approval.

How DentaSmart Helps

DentaSmart explains real consequences. Our AI analysis helps you see the crack, the decay, or the bone loss. We explain what happens if you choose the 'cheaper' option versus the recommended one. We give you the confidence to say, 'I know this is necessary for my health,' even if your insurance company disagrees.

More insights to help you understand your oral health.

Insurance Problems3 min read

Why Does Dental Insurance Feel Misleading?

You pay your premiums every month, so you assume you're covered. Then you go to the dentist, get a treatment plan, and find out your insurance pays... almost nothing. Or worse, you get a bill weeks later for a procedure you thought was '100% covered.' It feels like a bait-and-switch.

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Insurance Problems3 min read

Why Do Annual Maximums Run Out So Fast?

You need a crown and a root canal. The total is $2,500. Your insurance says, 'Sorry, your annual maximum is $1,500.' You're responsible for the rest. In 1970, the average dental maximum was $1,000. Today, it's... still about $1,500. The cost of care has skyrocketed, but the coverage cap has stayed frozen in time.

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Insurance Problems3 min read

Why Are Waiting Periods Risky?

You sign up for a new dental plan because you have a toothache. You go to the dentist, only to be told, 'Your plan has a 6-month waiting period for major work.' You can't get the crown you need unless you pay full price. So, you wait. And while you wait, the tooth gets worse.