If you’re planning a major oral surgery such as wisdom teeth removal, you may wonder if your medical insurance can cover your dental treatment. Yes, medical insurance may cover some oral surgeries, but not all of them. We understand that there is an inherent link between your dental health and your overall health, and depending on the procedure, your medical insurance may cover all or just a portion of the expenses. Let’s dive deep into what constitutes a medical or dental procedure and who covers it.
Medical Insurance vs. Dental Insurance: Who Decides?
Both medical and dental insurance claims use specific codes to describe the service performed. These codes outline the type of surgery, the surgery’s difficulty, which tooth is involved, and whether anesthesia or sedation needs to be involved, among other things. The insurance policy will then determine which codes are and aren’t covered.
Do I Need to See an Oral Surgeon?
Seeing an oral surgeon is the best way to discover if one of your plans covers a particular procedure. Processing medical insurance claims are different from dental claims, so you need to visit a specialist like an oral surgeon with experience filing medical claims. Additionally, a treatment coordinator will break down your benefits, so you’ll know which services are covered, who will cover them, and how much your insurance company will pay.
When Will Medical Insurance Cover Oral Surgery?
Whenever a specialist performs an oral procedure that’s considered medically necessary, you may have the option to file a medical claim. This means the oral surgery must be required for your body’s overall health and wellness. For example, a problematic wisdom tooth surgery might require more than standard dental procedures to complete the extraction successfully.
Which Dental Procedures Are Billed as Medical Procedures?
Four common types of dental procedures can be billed as medical procedures. These include:
These procedures are used to diagnose a medical condition. For example, an X-ray to find the location of your impacted teeth can be considered a medical diagnostic procedure. Other examples include medical imaging, bacterial testing, models, stents, examinations, and consultations.
Non-surgical Medical Procedures
If it treats a medical condition, a non-surgical procedure unrelated to a traumatic injury may be billed as a medical procedure. Some examples include incisions and drainage of abscesses, emergency treatments for infection and inflammation, and TMJ and sleep apnea appliances.
Surgical treatments can usually be billed as medical procedures. Examples include soft and hard tissue biopsies, cancer-related treatments, dental implants, complicated wisdom tooth extractions, and medically necessary tooth removals. However, you may need a physician referral for a preventive removal.
Treatment for Dental or Facial Trauma
Treatment for traumatic dental or facial injuries — e.g., car accidents — can be billed as medical procedures. However, depending on the circumstances, you may want to check if your auto, homeowners, or other liability insurance can cover the injury. They may or may not provide better coverage than your medical insurance.
Finding Ways to Save on Oral Surgery
If you need oral surgery, your medical insurance may cover the procedure, depending on your situation. However, you may want to also consider a dental savings plan. It may be used along with your dental insurance for even more savings on your dental care, allowing you to save 10-60% on most dental procedures. This must be coordinated with your insurance and doctor(s).
While traditional dental insurance has deductibles, annual caps, waiting periods, and restrictions around pre-existing conditions, dental savings plans do not. You might prefer a dental savings plan for your oral surgery rather than risk a claim denial. If you’d like to learn more, you can call us at 1-833-735-0399, and we can answer any questions about how a dental savings plan can help you obtain the timely dental care you need.