Tooth extraction not covered, wisdom teeth only

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Tooth extraction excluded from cover

Fiona* made a claim to the insurer for the cost of the surgical removal of a supernumerary (extra) tooth, which her son needed. The claim was declined, as the policy only provided cover for the extraction of wisdom teeth, and excluded “all other dental treatment” including, but not limited to, “periodontal surgery, orthodontal, endodontal or prosthodontal surgery.”

Fiona thought the exclusion shouldn’t apply as it wasn’t dental treatment; rather, it was medically necessary oral surgery. Further, his surgery could only be performed by an oral surgeon, in hospital, with general anaesthetic.

The case manager found that only the specific oral surgery listed (surgical removal of wisdom teeth) was covered. The phrase “All other dental treatments” in this context included oral surgeries relating to teeth and, on this basis, the case manager believed Fiona’s son’s surgery was excluded. The insurer was entitled to decline the claim.

Complaint not upheld.

*Names have been changed.

See the full case study.