If you’ve ever experienced teeth grinding or jaw clenching at night, you know how uncomfortable and potentially harmful it can be.
Whether it’s caused by stress, misalignment, or another factor, the solution might be as simple as wearing a night guard.
However, many people hesitate when it comes to purchasing one because of the cost. Night guards, though helpful, can be expensive, and not everyone knows that insurance might cover at least part of the cost.
If you’ve been wondering how to get a night guard covered by insurance, you’re not alone. It can feel like a complicated maze to navigate.
But don’t worry! In this article, I’ll break it down step-by-step so you can get the coverage you deserve.
We’ll explore everything from the basics of night guards, to how insurance works with them, to the specific steps you can take to get the cost covered.
Why You Need a Night Guard
Before diving into the insurance details, let’s quickly understand why a night guard is important. Many people grind or clench their teeth while they sleep, often without even realizing it. This condition, known as bruxism, can lead to a host of dental issues, including:
- Worn-down teeth: Constant grinding wears down your enamel.
- Jaw pain: Tightening and clenching your jaw muscles can cause discomfort and headaches.
- Tooth sensitivity: Enamel erosion may make your teeth more sensitive to hot or cold foods and drinks.
- Sleep disruption: Bruxism can cause restlessness and disturb your sleep, leaving you tired the next day.
A night guard can help protect your teeth from damage and relieve some of the pain associated with grinding or clenching. But getting one without breaking the bank is the tricky part, which is where insurance comes in.
What Is a Night Guard?
A night guard is a dental appliance that fits over your teeth while you sleep. It is designed to protect your teeth from the effects of bruxism (teeth grinding) and jaw clenching.
There are different types of night guards, but the main purpose is to prevent damage to your teeth and reduce strain on your jaw muscles.
Types of Night Guards
- Boil-and-Bite Guards: These are the least expensive and are typically available over-the-counter. You boil them in water and then bite into them to mold them to the shape of your teeth. While they are affordable, they might not offer the best protection.
- Custom-Made Night Guards: These are made by your dentist and are specifically designed to fit your mouth. They are typically more expensive but provide a much higher level of comfort and protection.
- Soft Night Guards: Made from soft material, these are comfortable and suitable for mild teeth grinders.
- Hard Night Guards: These are made from a firmer material and are best for severe grinders or those with TMJ (temporomandibular joint) disorders.
Now that you have an idea of what night guards are and how they work, let’s talk about getting them covered by insurance.
How Does Insurance Work for Night Guards?
When it comes to insurance, most dental plans treat night guards differently than regular dental services. They are often considered a preventive treatment or a medical device.
This means that while some insurance policies may cover them, others might not. The extent of coverage can vary widely based on your insurance plan, and many people are unaware that their insurance might provide reimbursement.
Dental Insurance vs. Medical Insurance
- Dental Insurance: Some dental plans provide partial or full coverage for night guards, especially if they are deemed medically necessary (for example, if bruxism is causing significant damage or pain).
- Medical Insurance: In some cases, medical insurance might cover a night guard if it’s prescribed to treat a medical condition like TMJ or severe bruxism. This is usually more difficult to get approved, but it’s worth checking with your provider.
To get a night guard covered by insurance, you typically need to follow a few steps, which I’ll outline next.
Step-by-Step Instructions: How to Get Your Night Guard Covered by Insurance
Navigating the insurance process can feel like a daunting task. But don’t worry! Below, I’ll break down the steps you need to take to ensure that you’re getting the best possible chance for coverage.
Step 1: Visit Your Dentist
The first step is always to consult with your dentist. If you’re grinding your teeth at night, you likely need a night guard to protect your dental health. Your dentist can assess the extent of the damage and determine whether a night guard is necessary.
- Obtain a diagnosis: For insurance to cover the cost, you may need a formal diagnosis of bruxism, TMJ disorder, or another condition that justifies the need for a night guard.
- Get a prescription: If your dentist agrees that a night guard is needed, ask for a prescription. This will help with both dental and medical insurance claims.
Step 2: Check Your Insurance Plan
Once you have your dentist’s recommendation and prescription, the next step is to check with your insurance provider to see if they cover night guards. Here’s how to do that:
- Call your dental insurance company: Ask them if night guards are covered under your plan and, if so, under what conditions (e.g., if they are medically necessary).
- Call your medical insurance company: If you’re hoping to get your night guard covered under medical insurance (for TMJ or severe bruxism), contact your provider to confirm what documentation is required.
- Ask about the reimbursement process: Some insurers will require you to pay for the night guard upfront and then submit a claim for reimbursement.
Step 3: Submit Documentation
If your insurance provider requires specific documentation, you’ll need to make sure you have everything in order. This might include:
- A copy of your dentist’s prescription
- A copy of your diagnosis (if applicable)
- Receipts for payment
Check with your insurance provider to see what specific documents they need and how to submit them.
Step 4: Wait for Approval
Once you’ve submitted all the necessary paperwork, your insurance provider will review the claim. Depending on the provider and the complexity of your situation, this process could take anywhere from a few days to a few weeks.
- Follow up if necessary: If you don’t hear back within a reasonable timeframe, it’s okay to call and ask about the status of your claim.
Step 5: Get Reimbursed or Covered
If your insurance claim is approved, you’ll either receive full reimbursement or your insurance will directly cover the cost of the night guard. Be sure to follow up with your dentist or insurance provider if you encounter any issues with the approval or reimbursement.
Common Mistakes to Avoid When Getting Your Night Guard Covered by Insurance
While the process can seem straightforward, there are several common mistakes that people make when trying to get a night guard covered by insurance. Here are some to avoid:
- Not Getting a Prescription: Some insurance companies require a prescription or formal diagnosis to approve coverage. Make sure you don’t skip this step.
- Assuming All Night Guards Are Covered: Not all night guards are covered, especially if they are purchased over-the-counter or through a third-party vendor. Custom night guards are often more likely to be covered, so double-check with your insurance provider.
- Not Keeping Documentation: Keep track of all receipts, prescriptions, and communication with your insurance provider. Missing paperwork can delay or deny your claim.
- Not Asking About Coverage Limits: Some plans have a yearly limit for dental appliances, including night guards. Make sure you know your coverage limits before submitting a claim.
Conclusion
Getting a night guard covered by insurance doesn’t have to be a headache. By following the steps outlined in this article and being diligent about your paperwork, you can increase your chances of having at least part of the cost covered.
- Consult with your dentist for a proper diagnosis and prescription.
- Check both dental and medical insurance to see what coverage options are available.
- Submit the required documentation to your insurer and follow up as needed.
With these steps, you can take control of your dental health without breaking the bank.
FAQs
1. Will my insurance cover a night guard for teeth grinding?
It depends on your insurance plan. Some dental insurance policies cover night guards if they are deemed medically necessary. Check with your insurer for details.
2. Can medical insurance cover a night guard for TMJ?
Yes, medical insurance may cover a night guard if it’s prescribed for TMJ or other medical conditions. However, this can be more difficult to get approved than dental coverage.
3. How much do night guards typically cost?
Night guards can range from $20 for over-the-counter models to several hundred dollars for custom-made ones from your dentist. Costs vary depending on the type and the provider.
4. Can I buy a night guard online and get it reimbursed by insurance?
It’s unlikely that insurance will cover a night guard purchased online unless it is specifically recommended by your dentist. Custom night guards are more likely to be covered by insurance.
