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  • Writer's pictureAhsan Malyk

Does Medical Insurance Cover Dental Surgery?

Good dental health is an indicator of overall health. Yet, according to his 2017 CDC data from 2014, it is estimated that only 50.2% of adults (ages 18 to 64) have dental insurance each year to maintain oral health.

Health insurance sounds like it covers everything related to health, from doctor visits to dental care, but it is usually not covered. In fact, dental insurance is a completely different insurance product.

But what about dental emergencies and surgeries? Read on to find out how health insurance can help cover the cost of some dental procedures.

Does health insurance cover oral surgery?

The answer is bittersweet. Some dental treatments are covered by health insurance and some are not. The real problem is that many Americans (an estimated 76.5 million) do not have dental insurance. So if their health insurance doesn't cover dental surgery and the cost is too high, they probably won't go ahead with oral care.

What you need to know about insurance accounting

Health and dental plans use codes (instructions) to bill your policy. If your plan covers the code, your insurance company will receive and mail you a bill for your treatment. The dental insurance code usually answers:

  • Type of surgery/treatment performed

  • process complexity

  • Which tooth has undergone surgery or treatment?

  • Was anesthesia or sedation used?

A dental case is not as simple as a doctor's bill, so there may not always be a clear bill or answer as to who is responsible for paying the bill, whether medical or dental. not. All health insurance plans are different, so before you book a dental appointment, check your insurance plan to see if it covers all, some, or none of your procedures. .

Every situation is different when it comes to paying for dental care. For example, in certain circumstances, policyholders must first bill their medical company, while in other circumstances, they will be required to make a claim for a dental plan prior to treatment.

The bottom line is, before any dental treatment, talk to your dentist (who may know if your health insurance covers it) and your health insurance company to see if they cover oral work. to see if it is, and if so, how it will be billed.

Medical vs Dental Insurance

Insurance companies who want to avoid headaches should familiarize themselves with health insurance coverage. In general, health insurance covers everything medically necessary, but dental plans cover preventive care. Anything that directly affects quality of life and health is medically necessary.

Dental insurance can also help cover the cost of orthodontics and prosthetics (dentures). In addition, under certain medical conditions, health insurance can be claimed for dental services.

What dental treatments are covered by health insurance?

These are typical dental policies that your health insurance may cover.

  • Certain exams and X-rays, such as Panorex X-rays

  • oral infections, sores, or cysts

  • Tomography and bone beam diagnostics (CBCT).

  • temporomandibular joint device

  • headache treatment

  • sleep apnea device

  • Mouth trauma (accident)

  • Mucositis and stomatitis (usually due to chemotherapy)

  • infant tongue surgery

  • bone grafting and dental implants

  • Wisdom tooth removal (in many diseases)

  • biopsy

  • Dental examination before chemotherapy or surgery

  • Care and treatment of facial pain

  • jaw pain botox

  • birth defects

  • First aid

  • Orofacial disease examination

This is not an exhaustive list and may not apply in all cases. Always check with your insurance company to see what is covered before you charge for dental care.

Gray area: Anesthesia, Sedation, and Implants

A common question is whether health insurance covers anesthesia, sedation, or implants. Unfortunately, the answer is not easy. Here's what you should know:

  • Anaesthesia: Health insurance often covers anesthesia performed by a licensed anesthesiologist. If not, it is situational and may be covered by health or dental insurance.

  • Sedation: Nitrous oxide or oral sedation is usually covered by additional dental insurance.

  • Implant: Implants are difficult. If the cause is oral cancer or bone loss, it is usually covered by health insurance. If you are unsure whether dental treatment is covered by your health or dental insurance, we recommend that you check with your insurance company in advance.

Does health insurance cover dental treatment?

Maintaining good oral health is paramount to maintaining optimal health. Health insurance does not typically cover routine dental and preventative care, but it may cover dental surgery.

If you need dental surgery, contact your insurance company to see if your health insurance will cover the cost. There's nothing wrong with asking, and you may find that your health insurance company will pay for your dental surgery.

Who decides if my oral surgery is covered by medical or dental insurance?

Health and dental insurance claims are sent with specific codes used to describe the services provided. The code describes the type of oral surgery, complexity, teeth involved, anesthesia/sedation, etc. The insurance policy specifies which codes are covered and which are not.

The best way to find out if a particular procedure is included in one of your plans is to work with a dentist or professional (such as an oral surgeon) who has experience filing medical claims.

Health insurance claims are not the same as dental claims, so you need to work with someone who understands the process. Your treatment coordinator can get a breakdown of your benefits so your care plan shows an estimate of what services will be covered, who will pay for them, and how much your insurance company will pay.

With your written treatment plan in front of you, you can see which insurance plan will pay for a particular procedure and an estimate of your out-of-pocket costs. Unfortunately, these are just estimates. Coverage for this particular procedure is your responsibility as your dental or medical insurance may refuse to pay the claim.

When sedation or anesthesia is involved

Anesthesia and sedation for oral surgery can usually be expected to be paid for by health or dental insurance. General anaesthesia performed by a licensed anesthesiologist may fall under the health insurance category. Oral sedation or nitrous oxide (laughing gas) is usually billed by dental insurance.

Some types of oral surgery are performed in a hospital because of the complexity of the treatment and the type of anesthesia used (e.g. intravenous or intravenous). In such cases, you should make sure that your health insurance will help pay for it. Failure to do so may result in significant hospital bills.

why are you having surgery? In some circumstances, health insurance may cover oral surgery only if it is deemed "medically necessary". That means you need it for your body's overall health and well-being for its daily function. may take a while. Depending on your medical condition, you may be eligible for dental insurance based on your health insurance.

Apply for medical or dental benefits

Some types of health insurance policies require the provider to bill the dental insurance company first, and once the claim has been processed, the claim can be submitted to the health insurance company.

A dentist or oral surgeon should provide supporting data and clinical records to demonstrate why a particular procedure should be completed in a certain way. An X-ray or intraoral image may be required. Again, health insurance is very different from traditional dental insurance, so anyone filing a medical claim should have a good understanding of health insurance.

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