Why didn't insurance cover my night guard?

• Not covered. Some plans exclude night guards. See Why doesn't my plan cover this at all?
• Too soon. Plans often pay for one guard every few years. A lost or broken guard before then usually isn't covered. See Insurance says I had this done too recently.
• Records didn't show grinding. Some plans pay only when your dentist's records describe signs of grinding, such as wear. See My treatment didn't meet the plan's criteria.
• It was for jaw joint treatment. Many plans cover guards for grinding but not for treating TMJ problems. See Will it help my jaw pain or headaches?
• The code didn't match. A guard for grinding and a device for jaw joint problems are billed under different codes. If the code on your EOB doesn't match what you were told it was for, ask the office about it.
• The usual limits: your annual maximum or a waiting period.

1. Find the exact reason on your Explanation of Benefits.
2. If it's about records, ask the office whether they sent notes or photos showing the wear, and whether they can send more.
3. If it's a frequency limit, ask whether there's a clinical reason you needed a new one sooner. Some plans make exceptions; see asking the plan for an exception.
4. Appeal if you and your dentist think the plan got it wrong. If your dentist is in network, the office usually handles the appeal.

If the guard isn't covered, you're usually responsible for it. Whether an in-network dentist can charge their regular fee or must stay at the plan's fee depends on the reason and your plan. Your Explanation of Benefits shows what's yours to pay. See Can an in-network dentist charge me more?

A predetermination before you're fitted shows whether your plan will pay. And keeping your guard safe in its case avoids paying for a replacement the plan won't cover yet.