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
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
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)
Dental examination before chemotherapy or surgery
Care and treatment of facial pain
jaw pain botox
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.