My Replacement Bridges Are Being Denied

One of the main reasons replacement bridges are denied and/or there is so much hassle with insurance companies is the failure to indicate that it is a replacement bridge on the claims.

Remember, when you are replacing an existing fixed bridge:

Replacement is not automatic just because it has met frequency requirements. There must be a structural reason: decay around a margin, etc. Fx porcelain, discoloration does not qualify for a new prosthesis.

If it has met frequency requirements and there is a valid reason for replacement, make sure you check the appropriate box on the dental claim (pre-d), indicate date of original placement if known and reason for replacement. A separate narrative may be included if more space is needed. Include radiographs if appropriate.

Note that some insurance companies (because of their internal policy and if there are other teeth missing and unreplaced in the arch), may allow benefits for crowns on the retainer teeth and a removable partial denture for all missing teeth despite that it is a replacement.

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