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  • Writer's pictureAhsan Malyk

Will Health Insurance Cover Wisdom Teeth Removal?

If you're considering major oral surgery, you probably have questions about whether your health or dental insurance will help with the expense.

The removal of unhealthy or impacted teeth, dental implants, biopsies, the removal of tumours, the healing of damage, and other surgical procedures involving the face's bones and soft tissues are all examples of oral surgery. Knowing how your insurance can help with the cost is vital because these surgeries can be very expensive.

Dental insurance has several advantages, including cheaper dental care costs and the capacity to maintain good oral health. Also, remember that your medical insurance carrier may classify many of the diverse procedures and treatments offered in a dentist practise as being medically related.

Is dental or medical insurance applicable to oral surgery?

Both your general health and your oral health might have an impact on the rest of your body. Some of the costs associated with a major dental procedure, such as oral surgery, can be covered by both your medical and dental insurance plans.

Depending on your insurance company and plan coverage, your medical insurance may or may not pay for a dental-related surgery. Most of the time, significant oral surgery operations are covered by medical insurance coverage.

We advise you to ask the office staff of your dentist or dental specialist if they have any experience with filing medical claims.

When will my health insurance cover oral surgery?

Your dental insurance company partially covers most of routine oral operations. However, it also depends on your dental plan, degree of coverage, and the precise sort of surgery you require.

Depending on your plan, your medical condition, the nature and level of difficulty of the surgery, and other factors, your medical insurance may also cover the cost of medically necessary oral surgery procedures in full or in part. A medically connected oral condition's costs for diagnosis, treatment, or prevention, as well as for retraining any lost skills, may be covered.

Does a general dentist have the ability to provide the care I require, or do I need to see an oral surgeon?

General dentists, dental specialists, including oral surgeons, can submit claims to medical insurance for specific procedures. Review the details of your specific dental insurance plan to determine whether the procedure will be covered by dental insurance or whether you should involve your medical insurance provider.

Your dental and medical insurance occasionally cover a portion of your care. When that occurs, you or your dental professional can ask one or both insurers for a pre-treatment estimate to obtain a clearer idea of the costs you will incur.

What dental treatments are covered by health insurance?

Your insurance company may bill various dental procedures as medically related dental procedures, depending on the situation. Several instances include:

The correction of facial abnormalities, cancer-related treatment, dental implants, difficult wisdom tooth extractions, other complex tooth removals, soft tissue and hard tissue biopsies, frenectomies on infants

  • Dental/facial trauma, including damage from car accidents or other types of mishaps, such as knocked-out or lose teeth.

  • Diagnostic techniques, including some (non-routine) X-rays, bacterial tests, and treatments to identify the cause of myofascial and mouth pain

  • Non-surgical medical procedures, such as abscess drainage, TMJ or sleep apnea equipment, general anesthesia for surgeries, and emerging therapies for inflammation and infection.

In some cases, many routine dental procedures may be claimed as medical procedures. In light of this, submitting your oral surgery claims to your health insurance can be a useful strategy to stretch your medical budget.

Your dental insurance company and your medical insurance company must work together to submit this claim. When you have two dental insurance plans, it is referred to as coordination of benefits (COB), which is identical to the claim filing procedure.

Some medical insurance plans demand that your provider submit a dental insurance claim first, which must be processed before you may submit a claim for medical insurance. Even if your medical and dental insurance are provided by the same insurance provider, coordination is still crucial.

Remember that medical insurance may have high deductibles that must be met before any payments are made. We advise speaking with your dentist or oral surgeon if you have any inquiries.

Cheap Options for Oral Surgery

If your dental insurance plan is a part of an HMO, it will cover wisdom tooth extraction in young patients if your dentist recommends it.

Finding an oral surgeon who accepts your health insurance is the catch. In my son's instance, the state-funded dental insurance that paid for his braces was essentially useless for his wisdom tooth extraction.

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