Questions & answers · Dental insurance
What written exclusions in Delta Dental of Colorado's dental insurance policy can lead to a denied claim?
AI-drafted from filed documents · reviewed: pendingcommon reasons a claim is deniedDelta Dental of Colorado
Under Delta Dental of Colorado’s filed form, claims may be denied for crowns and metallic onlays if the tooth can be restored by an amalgam or composite filling, or if less than 84 months have passed since the last placement of a crown, onlay, or core buildup on the same tooth [3]. Claims for stainless steel crowns or resin crowns may be denied if the service occurs within 36 months of a prior placement, or if a prefabricated resin crown is placed on a tooth other than a front tooth [3]. Core (crown) buildups including pins are not covered for children under age 16 [3]. Metallic inlays are not covered for children under age 16 [2]. Temporary restorations and appliances are not covered separately [2]. This does not appear in these excerpts — check the full policy.
Information only — not legal advice. The insurer decides.
These answers quote forms insurers filed with state regulators. Your own policy, its endorsements and your state’s rules control. A filed form may not be the version sold to you.
Where this comes from (3)
[1] Delta Dental of Colorado · CO · SERFF DDCO-134935031 · p. 7 · 33 · Pin Retention
Pin Retention Covered with a basic (amalgam or composite) filling. A benefit one time per filling. Extraction - coronal remnants deciduous tooth Includes local anesthesia and routine post-operative care, which are not covered separately. Extraction - erupted tooth or exposed root Includes local anesthesia and routine post-operative care, which are not covered separately. Adjunctive Services Services related to another category of covered services will be covered at the same percentage as the related category of covered services.
[2] Delta Dental of Colorado · CO · SERFF DDCO-134935031 · p. 10 · 61 · TYPE IIIB – INLAY, ONLAY, IMPLANTS AND CROWN SERVICES
TYPE IIIB – INLAY, ONLAY, IMPLANTS AND CROWN SERVICES (Temporary restorations and appliances are not covered separately.) Procedure Benefit Description Metallic Inlays An alternate benefit allowance for an amalgam filling will be made for the same number of surfaces. Any difference in fee is chargeable to the patient. It will be covered if 84 months have passed since the last placement. Not covered for children under age 16. Crowns and Metallic Onlays Covered when the tooth cannot be restored by an amalgam or composite filling and if more than 84 months since the last placement. Not covered for children under age 16. … (excerpt — the filed text continues)
[3] Delta Dental of Colorado · CO · SERFF DDCO-134935031 · p. 10 · 61 · Crowns and Metallic Onlays
Crowns and Metallic Onlays Covered when the tooth cannot be restored by an amalgam or composite filling and if more than 84 months since the last placement. Not covered for children under age 16. Stainless Steel Crowns, Resin Crowns Covered once in 36 months when the tooth cannot be restored by a filling. Prefabricated resin crowns are a benefit only on front teeth. Replacement of a prefabricated crown is not covered within 36 months of placement of an existing prefabricated crown. Core (Crown) Buildup including any pins Covered when needed to retain a crown or onlay and when need is due to extensive loss of tooth structure caused by decay or fracture. Covered only if 84 months have passed since the last buildup or post and core procedure for the same tooth. Not covered for children under age 16.
Drafted by a local AI model from the excerpts above, then checked by rules (citations, no rankings, no “not covered” claims from a partial excerpt). Question id Qf0168185. Spotted an error? Tell us.