Insurance term
Missing Tooth Clause
Definition
A missing tooth clause is a plan provision that won't pay to replace a tooth that was missing before the patient's coverage began.
Why it matters for the front desk
The clause affects bridges, implants and dentures, which are among the most expensive treatments a practice offers. A patient who lost a tooth before joining the plan may find that replacing it isn't covered at all, even after the waiting period. The clause rarely appears in a basic eligibility response, so ask the payer directly whenever a treatment plan replaces missing teeth, and note the extraction date in the chart.
Related terms
- Waiting Period A waiting period is the length of time a patient must be enrolled in a plan before certain services are covered.
- Preauthorization (Predetermination) A preauthorization, usually called a predetermination or pretreatment estimate in dentistry, is a request sent to the payer before treatment asking what it will cover.
- Eligibility Verification Eligibility verification is the process of confirming, before an appointment, that a patient's dental coverage is active and what it will pay for.