If Your Front Tooth Breaks, Is Dental Fracture Treatment Covered by Insurance?

If your front tooth breaks, is dental fracture treatment covered by insurance?

Hello, I’m the director of Seoul Bardi Dental Clinic.

Did you know that when a tooth breaks,

you may be able to receive compensation through indemnity insurance (actual-cost reimbursement insurance)?

Not all indemnity insurance policies apply,

but depending on the conditions,

non-covered treatments such as resin and crowns may also be reimbursed.

Today, through the case of a patient who came in with a fractured front tooth,

I will explain what treatment is done when a front tooth breaks, and how dental fracture treatment can be claimed through insurance.

<Table of Contents>

1. Treatment options when a front tooth breaks
2. Can dental fracture treatment be claimed through insurance?
3. Real case of actual-cost reimbursement after front tooth resin treatment

1. Treatment options when a front tooth breaks If your front tooth breaks, is dental fracture treatment covered by insurance?

The treatment method for a broken front tooth

depends on the extent of the break and whether the nerve is damaged.

1. If only a small area is broken – resin treatment

If only the tip of the front tooth is slightly chipped and there is no crack reaching the nerve or root,

a tooth-colored material called resin is most commonly used to fill the area.

In many cases, treatment can be completed on the same day, and because the result is aesthetically natural,

it is often chosen for front tooth fractures.

2. If the broken area is large, or the tooth is in a high-load area – crown

If the amount of damage is large or the tooth is in a position that takes a lot of biting force, resin may not last for long.

In such cases, a crown, which covers the entire tooth, is considered.

3. If the crack reaches the nerve – root canal treatment + crown

If the fracture is deep and the nerve is damaged, or if there is severe pain when chewing,

the general treatment flow is to first perform root canal treatment to remove the damaged nerve,

and then finish with a crown to protect the remaining tooth.

However, if the tooth is split all the way to the root, extraction may be necessary.

2. Can dental fracture treatment be claimed through insurance? If your front tooth breaks, is dental fracture treatment covered by insurance? Whether dental treatment can be reimbursed through indemnity insurance varies greatly depending on when the policy was purchased.

1. First-generation indemnity insurance (Policies purchased from October 2003 to September 2009)

If this period’s indemnity insurance included an injury medical expense rider,

it has the characteristic of reimbursing dental fracture treatment costs at 100% for both covered and non-covered expenses, regardless of the type of medical institution.

If the tooth broke from something hard while eating, or if the front tooth broke due to trauma,

then for a dental fracture caused by an accidental incident,

non-covered treatments such as resin, inlay, and crown are highly likely to be reimbursed as well.

However, if a tooth weakened by decay breaks, it is not considered an injury

and is often excluded from reimbursement.

2. Policyholders who joined from the second-generation indemnity insurance onward From the second generation onward, the coverage structure changed significantly.

Regardless of whether it is an injury or illness,

only the out-of-pocket portion for covered items that are covered by national health insurance is reimbursed.

For example, covered items such as root canal treatment and gum treatment are paid after deducting the copayment.

However, non-covered treatments (resin, inlay, crown, implant, etc.) are excluded from reimbursement.

The final reimbursement result may vary depending on the specific riders included in each person’s insurance policy.

Therefore, regarding whether a claim is actually possible,

it is best to consult directly with the insurance company or the agent in charge for the most accurate answer.

3. Real case of actual-cost reimbursement after front tooth resin treatment If your front tooth breaks, is dental fracture treatment covered by insurance?

This patient came in after biting a crab with their front teeth, and the tip of the front tooth (incisal edge) had broken.

Fortunately, based on the photos and examination,

there were no signs that the crack had extended to the nerve or root.

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When the bite was checked, the upper front teeth were only slightly overlapping the lower front teeth, which was within the normal range of occlusion,

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so even if it were restored with resin, there was not a high likelihood that it would break again easily.

So on the day of the visit, we restored the front tooth naturally with resin.

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The patient also looked relieved while seeing the front tooth restored to the same appearance as before it broke.

There was also something that helped the patient on the insurance side.

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This patient had first-generation indemnity insurance, and was in a situation where a dental fracture insurance claim was possible.

So we guided them on the documents they needed to submit.

As a result, they were able to receive reimbursement for the cost of the non-covered front tooth resin treatment as well.

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After treatment, the patient said,

“I thought dental treatment was hardly covered by insurance, so I was about to give up, but thanks to your detailed explanation, the burden was greatly reduced.”

They expressed their thanks several times.

I was also very glad that I could help the patient put aside both treatment and cost concerns.

When a front tooth breaks, worries about treatment and cost usually come together.

Rather than worrying alone,

it is better to accurately check the cause of the fracture and the current condition of the tooth,

and see how much can be reimbursed through the indemnity insurance you have.

If there is a part that needs treatment, I will explain it calmly. Thank you.

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| This post was written directly by Seoul Bardi Dental Clinic for the purpose of providing medical information in compliance with Article 56, Paragraph 1 of the Medical Service Act regarding medical advertising. The provided information is for reference only, and we recommend that you visit a medical institution and receive guidance from medical professionals for symptom assessment and accurate management methods. All procedures / surgeries performed at the dental clinic may involve risks depending on the individual (such as inflammation, bleeding, swelling, etc.). Please make your decision after sufficient consultation with the medical staff in advance. The treatment cases in this post were photographed with the consent of the patients who completed treatment at our clinic, and the before-and-after photos were taken under identical conditions. |