Insurance and billing
Missing tooth clause
A plan rule that may refuse to pay to replace a tooth lost before the coverage began.
A missing tooth clause is a term in some dental plans that says the plan will not pay to replace a tooth that was already missing when coverage started. It most often affects bridges, dentures and implants. Not every plan has one, and details differ. Check the plan and the patient's history before presenting an estimate for tooth replacement, since a denied claim can leave the patient with an unexpected bill.
Example at the front desk
The plan has a missing tooth clause, so the bridge may not be covered, and I told him before booking.