Posted by If you know that oral surgeries cost between $2000 to $5,000 on average, then you may be asking “Is oral surgery covered by dental or medical insurance?” The good thing is, we’ve worked out the answer.
Both dental and medical insurance can cover and does cover oral surgery but it depends on the classification of the surgery.
In this article, we have explained how categorization works for both insurance types and how to get the insurance you actually need!
Stay put!
Table of Contents
Is Oral Surgery Covered By Dental Or Medical Insurance?
Both medical and dental insurance provide coverage for oral surgery depending on the category the surgery falls into. It could be medical if it is extensive and affects other areas beyond your mouth, and it could be dental if it only affects your mouth.
Sometimes even, both medical and dental insurance can intersect and cover different aspects of oral surgery. This all depends on how well you and your dentist understand your situation and file a claim.
How Medical Insurance Can Cover Your Oral Surgery
The key to having your medical insurance cover your oral surgery is if your condition affects your overall health and well-being, not just your mouth. This means that treatments that could be classified as purely dental will not be covered by medical insurance.
Let’s take a quick look at specific aspects of your oral health that medical insurance covers:
- Accidents and injuries
- Medical conditions
- Anesthesia
- Diagnostic procedures
- Surgical procedures
- Non-Surgical Medical procedures
- Follow-up Care
- Hospital Stays
Let’s talk about them briefly:
- Accidents and Injuries: If you happened to have suffered a traumatic incident that affected your mouth, you are likely to obtain medical insurance as this is believed to extend past your mouth region
- Medical Conditions: Conditions like overbites, an abscessed tooth, and even diabetes fall under the umbrella of medical conditions that are generally covered by medical insurance regardless of whether one has a dental insurance plan in place.
- Anesthesia: If you are administered anesthesia by a licensed anesthesiologist, before an oral surgery. The chances are that it will fall under medical coverage.
- Diagnostic Procedures: Procedures like examinations, consultations, medical imaging stents, and tests that show the source of pain are all part of medical procedures that are covered by medical insurance. Routine X-rays for preventive care treatment are not part of this.
- Surgical Procedures: Certain surgeries can be considered by medical insurance. Procedures like medically necessary tooth removal organ transplant, and radiation therapy fall under this category.
- Non-surgical medical Procedures: These include emergency treatment for infection or inflammation, curettage of periodontal abscesses, incision and drainage of abscesses, fluoride trays for patients undergoing cancer treatments, and bulimic patients. All of these can be covered by medical insurance as long as they are considered medically necessary.
- Follow-up Care: You may need to see your doctor after surgery for follow-up care, like stitches removal and medication management. Medical insurance would cover some or all of these expenses. Just check with your network provider to be sure.
- Hospital Stays: Although this depends on the insurance policy, hospital stays can be covered by medical insurance. There could be limitations and exclusions, so check with your insurance provider
Oral Surgeries Covered By Dental Surgery
Some of the oral surgeries covered by dental surgery include:
- Preventive Treatments
- Basic treatments
- Extractions
- Root Canals
- Crown and Bridges
- Implants
Let’s quickly discuss them:
#1. Preventive Treatments:
These include routine cleanings, x-rays, and fluoride treatments. Most dental insurance plans provide complete coverage for the cost.
#2. Basic Treatments:
Simple treatments like cavity filling, can also be covered by dental insurance. Coverage for these usually extends to a certain percentage.
#3. Extractions:
Removal of teeth that are damaged, decayed, or infected are procedure that can easily come under the dental insurance coverage umbrella.
#4. Root Canals:
This procedure is used to save a tooth that is severely damaged or infected. It is a purely dental procedure, therefore it is covered by dental insurance
#5. Crowns and Bridges:
These prosthetic devices are used to replace missing teeth or protect a damaged tooth. They are also restricted to the mouth and can only be covered by dental insurance.
#6. Implants:
Implants are used to replace missing teeth. They are surgically placed in the jawbone and act as an anchor for a dental crown or bridge. Although they could be considered medical, they are usually purely dental treatments.
Check out this helpful guide – Does Dental Insurance Cover Second Opinions?
How To Properly Classify If Your Surgery Should Be Covered By Medical or Dental Insurance
Getting the appropriate information to properly classify your procedure can be daunting if you don’t get adequate help. Here are a few things that will help:
#1. Speak To Your Dentist/Oral Surgeon:
Having a conversation with your dentist is one of the best you can do to facilitate your treatment. This is because grouping an oral surgery or aspects of it for insurance coverage largely depends on what the procedure involves. The person with a comprehensive grasp of the information needed is your dentist/oral surgeon.
What your dentist does is group several aspects of your treatment under the boxes as indicated by your insurance plans. This is to enable you to properly file a claim.
Your dentist/oral surgeon will also provide you with the necessary documents that will serve as backing to obtain your claim. These include X-rays and even intraoral photographs.
#2. Contact Your Insurance Provider:
Your insurance provider takes up the work from your dentist to help you obtain insurance. In order to obtain the right claim, they ought to have good knowledge of medical coverage as well as dental coverage.
You may wonder why this is necessary. Your medical and dental insurance plan have specific codes that represent specific treatments that they have to pay the bills for. A knowledge of what each represents is important so you don’t cheat yourself.
Also filing a medical insurance claim is a different process from filing a dental insurance claim. You will need a provider who knows both to adequately get you the help you need
How Medical and Dental Insurance Claims Differ
Although filing dental and medical insurance claims may look similar, here are the key differences:
- The forms that are used to file claims are often different.
- The codes that are used to bill for services are also different. Dental insurance uses codes from the American Dental Association (ADA), while medical insurance typically uses codes from the International Classification of Diseases (ICD).
- In addition, the information that is required on the claim forms often differs. For example, dental claims typically require information about the teeth that are to be treated, while medical claims often require information about the diagnosis.
How To Properly File A Claim For Insurance Coverage For Oral Surgery
With all the information you’ve got so far, it is important you know how to go about filing a claim, and here are the important steps to take:
- Gather all the information necessary. This includes your claim form, insurance ID card, and all the documents obtained from your dentist/oral surgeon to back your claim.
- Carefully fill out and complete the claim form. Ensure you get all the necessary help you need to make this work.
- Find out the method of submission and submit your claim to your insurance company.
Other Ways To Cover Your Oral Surgery Bill
Insurance is not the only way to pay for your oral surgery. Here are proven methods you can try!
- Dental Savings Plans: This could seem like a long trip, but it could get you there if you don’t have insurance. These plans offer you the option of saving up tax-free money for your dental procedures, oral surgery inclusive!
- Dental Clinics: These allow you to get your treatment at a low cost. Dental clinics also offer discounts that cut off a huge chunk of your bill.
- Medicaid: Although this does not always work, it is worth trying. Medicaid can cover oral surgery for you if you are eligible. Check in with the health service in your state to know if you qualify.
Frequently Asked Questions
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Important Recommendation
- Does Dental Insurance Cover Porcelain Crowns?
- Does Dental Insurance Cover Crown Replacements?
- Does Dental Insurance Cover Sedation?
- Does Dental Insurance Cover Gum Grafts?
- Does Dental Insurance Cover Anesthesia?
- Does Dental Insurance Cover Oral Cancer Screening?
Conclusion
I sincerely hope this article has helped you with the right information to know how to classify your oral surgery treatment and properly file a claim.
Remember, oral surgery like most treatments will always result in a little struggle when it comes to obtaining insurance. Alternatives are also there!
Cheers.