Paul Sanchez
Oral surgery can be expensive, so it's important to know how your insurance can help with the cost. Whether your medical insurance covers a dental-related procedure depends on your insurance provider, your plan coverage, and the type of surgery. Most common oral surgeries are covered, at least in part, by dental insurance providers, but this depends on the specific type of surgery, your dental plan, and your level of coverage. Medical insurance may cover the cost in full or in part for medically-related oral surgery procedures, depending on your plan, medical health status, and the type and degree of difficulty of the surgery.
| Characteristics | Values |
|---|---|
| Dental insurance coverage | Covers preventive and routine dental care, basic procedures, and major procedures |
| Medical insurance coverage | Covers medical care for illness, injury, and preventative care; may cover oral surgery if it is deemed medically necessary, resulting from an accident or injury, or related to a medical condition |
| Factors influencing coverage | Type of surgery, level of coverage, health status, age, insurance provider and plan |
| Determining coverage | Consult with dentist or oral surgeon, review insurance plan, obtain pre-treatment estimate |
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What You'll Learn
Medical insurance coverage
Firstly, it is important to understand the distinction between dental care and medical procedures performed in a dentist's office. Dental care focuses on preventive and basic procedures, such as cleanings, flossing, x-rays, fillings, and simple tooth extractions. On the other hand, medical procedures address diagnosed medical conditions, illnesses, non-biting injuries to sound teeth, or diseases and their symptoms.
In general, medical insurance plans may cover oral surgery procedures that are considered medically related. This includes cases where oral surgery is required due to trauma, accidents, injuries, or medical conditions such as oral cancer. For example, jaw surgery to correct sleep apnea or Temporomandibular Joint Disorders (TMJ) may be covered under medical insurance. Additionally, certain diagnostic procedures, such as non-routine X-rays, bacterial testing, and tests to identify the source of oral and myofascial pain, may be covered by medical insurance.
It is worth noting that medical insurance typically does not cover routine dental treatments, replacement of teeth, or procedures considered cosmetic, such as dentures, bridges, or crowns. However, this may vary depending on your specific insurance plan. Therefore, it is essential to consult with your insurance provider before undergoing any oral surgery to understand your coverage and potential out-of-pocket expenses.
To determine if your oral surgery will be covered by medical insurance, it is recommended to speak directly with your insurance provider. They can provide an estimate of their coverage and help you understand your plan's specifics, including deductibles and billing procedures. Additionally, discussing your treatment plan with your dentist or oral surgeon is crucial, as they may have experience filing medical claims and can advise on the likelihood of receiving coverage.
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Dental insurance coverage
Most common oral surgeries are covered, at least in part, by dental insurance providers. Oral surgeries can include the removal of diseased or impacted teeth, dental implants, biopsies, tumour removals, repair of trauma, and other surgical issues involving the bones and soft tissues of the face. However, this depends on the specific type of surgery, your dental plan, and your level of coverage.
It is important to note that dental insurance coverage for oral surgery may have waiting periods or limited coverage for the first year on the plan. It is always recommended to consult your insurance plan and provider before booking any dental surgery to understand your coverage and how to bill for it.
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Oral surgery types
Oral surgery refers to any operation done inside your mouth or jaw area. Oral surgery can be necessary for various reasons, including correcting bite issues, removing impacted wisdom teeth, tooth extraction, treating diseases, or injuries to the jaw. Oral surgery is performed by an oral or maxillofacial surgeon.
Wisdom tooth removal is a common oral surgery procedure. Wisdom teeth are the third molars that typically come in between the ages of 17 and 25. These teeth can cause problems when there isn't enough room to emerge properly, so wisdom tooth removal helps treat or prevent pain and infection. The process for wisdom tooth extraction is similar to that of regular tooth extraction, but it may be more complex and take longer to recover from.
Dental implants are another common oral surgery procedure. They are artificial tooth roots made from titanium alloy or zirconia that provide a permanent base for fixed, replacement teeth. Dental implants offer a more natural tooth replacement option than dentures. Dental implant surgery typically involves several steps and may require multiple visits to the oral surgeon.
Tooth extractions are also frequently performed oral surgeries. During a tooth extraction, a tooth is removed from its socket in the bone to prevent the spread of infection and make way for a new, healthy tooth or dental implant. Tooth extraction is typically a straightforward and relatively quick procedure.
Other common oral surgery procedures include dental bone grafts, which increase the volume and density of the jawbone, and gum grafts, which treat thinning or receding gums. Oral biopsies, tumour removals, and the repair of dental or facial trauma are also types of oral surgery.
The cost of oral surgery can be covered by either medical or dental insurance, or a combination of both. Whether your insurance covers oral surgery and to what extent depends on your specific insurance plan and the type of surgery you require. It is recommended to consult with your insurance provider beforehand to understand your coverage and how to bill for the procedure.
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Pre-treatment estimates
Oral surgery can be expensive, so it is important to know how your insurance can help with the cost. Before you undergo any dental procedure, it is advisable to consult with your dentist and insurance provider to determine if your health plan covers it and, if so, how to bill for it.
To receive a pre-treatment estimate, members can discuss the proposed dental treatment with their dentist and ask the dental office to request one from their insurance provider. The dental office then submits a treatment plan and supporting documentation (such as x-rays) to the insurance company for review. The insurance company reviews the documents and the member's benefits and provides a copy of the pre-treatment estimate to both the member and the dental office. This document includes a cost estimate based on the member's plan type, eligibility, current plan benefits, and the amount remaining in their annual maximum.
It is important to note that pre-treatment estimates are not binding, and factors may change between requesting the estimate and receiving care that could affect the final cost. For example, coverage may change, an annual maximum may be reached, or a member's age may exceed a procedure's age limitation.
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Payment options
Most common oral surgeries are covered, at least in part, by dental insurance providers. However, this depends on the specific type of surgery, your dental plan, and your level of coverage. Some dental plans do not cover major services and may not cover any part of your oral surgery. Additionally, dental plans can have waiting periods or limited coverage for the first year.
Your medical insurance may cover the cost in full or in part for medically-related oral surgery procedures, depending on your plan, medical health status, and the type and complexity of the surgery. Oral surgeries that may be covered by medical insurance include those related to dental/facial trauma, cancer-related treatments, and the diagnosis and treatment of medically-related oral conditions.
If your insurance does not cover the full cost of the procedure, there are other payment options available. Some oral surgeons offer accessible payment plans, where providing a significant first payment can allow the rest of the bill to be covered in ongoing installments. CareCredit is another option, offering a full range of payment plans, including short-term, long-term, and no-interest options. Alternatively, you may consider taking out a loan to cover the costs.
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Frequently asked questions
Whether your insurance covers oral surgery depends on the type of surgery, your insurance provider and your plan coverage. Most common oral surgeries are covered, at least in part, by dental insurance providers. However, your medical insurance may also cover the cost in full or in part for medically-related oral surgery procedures. This depends on your plan, medical health status, and the type and difficulty of the surgery.
Some examples of medically-related oral surgery procedures include:
- Surgical treatments – Difficult wisdom tooth extractions and other complex tooth removals, soft and hard tissue biopsies, frenectomies on newborns, correction of facial deformities, cancer-related treatment, and dental implants
- Dental/facial trauma – injuries resulting from automobile or other accidents, teeth that have been knocked loose or knocked out
- Diagnostic procedures – certain X-rays (non-routine ones), bacterial testing, and testing used to discover the source of oral and myofascial pain
- Non-surgical medical procedures – emergency treatments for inflammation and infection, drainage of abscesses, general anesthesia for surgeries, and appliances for TMJ or sleep apnea
You can consult with your dentist and/or oral surgeon, as well as your insurance provider, to see if your oral surgery is covered and how to bill for it. You can also ask your provider for a pre-treatment estimate, which will give you an idea of the expected costs.
