Is Oral Surgery Covered by Medical or Dental Insurance?

If you’re planning a major oral surgery (such as getting dental implants or needing your wisdom teeth removed) you may be wondering if it’s possible to get your medical insurance to cover your dental treatment. For people who don’t have great - or any -  dental insurance coverage, this can be a huge factor in whether it’s possible to move forward with your treatment.

The short answer to this question is that yes, medical insurance will cover some types of oral surgeries, but not all of them. In most cases, the two plans will overlap one another, picking up various aspects of the line-item expenses and expecting the other policy to pay for the ones that are not covered. 

Who Decides if My Oral Surgery Falls Under Medical or Dental Benefits?

Your medical insurance and dental insurance claims are filed with specific codes used to describe the service that is being rendered. Codes outline the type of oral surgery, how complicated it is, which tooth is involved, anesthesia/sedation, etc. The insurance policy will then dictate which codes are or are not covered.

The best way to find out if a specific procedure is covered by one of your plans is to work with a dentist or specialist (such as an oral surgeon) who has experience filing medical claims. Medical insurance claim processing is not the same as dental claims, so you need to work with someone who understands the process. A treatment coordinator will be able to get a breakdown of your benefits, so that your care plan outlines which services are covered, by whom they are covered, and an estimate of how much your insurance company will pay.

Once you have your written treatment plan in front of you, you’ll be able to see an estimate of which insurance plan pays for specific procedures and about how much will be left over for you to pay for out of pocket. Unfortunately, these are only estimates. Your dental or medical insurance may refuse to pay the claim, leaving you with the responsibility of covering that specific procedure. 

When Sedation or Anesthesia is Involved

If you’re undergoing anesthesia or sedation for an oral surgery, you can usually expect either your medical or dental insurance to pay for it. General anesthesia, administered by a licensed anesthesiologist, may fall under the medical insurance category. Oral sedation or nitrous oxide (laughing gas) would typically be billed to your dental insurance.

Some types of oral surgery are performed in a hospital setting, because of the complexity of the treatment or type of anesthesia being used (such as intravenous, or IV.) When that’s the case, you need to make sure that your medical insurance will help pay, or you could be left with a hefty hospital bill. 

Why are You Having the Surgery?

Depending on your situation, medical insurance may only cover your oral surgery if it’s deemed “medically necessary.” That is, you need it for the overall health and wellness of your body for everyday functioning. For instance, a complicated wisdom tooth surgery may require more than standard dental procedures to complete. Some medical conditions may entitle you to dental coverage under your health insurance. 

Filing Claims for Medical or Dental Benefits 

Some types of medical insurance policies require that your provider bill the dental insurance company first, and then once that claim is processed you can file a claim toward medical insurance. 

Your dentist or oral surgeon will need to provide supportive data and clinical notes to support why a particular procedure needs to be completed a certain way. X-rays or even intraoral photographs may be necessary. Again, the person filing the medical claims needs to have a good understanding of medical coverage, as it is very different from using traditional dental insurance. 

Other Ways to Save on Your Oral Surgery Bill

Having a medical claim denied is something that you obviously want to avoid. Instead of taking the chance at what-ifs, you might prefer to invest in a Dental Discount Plan – also known as a dental savings plan – where you can save a flat percentage off any dental procedure (including oral surgeries like wisdom tooth extraction and implant placement.)

Contact an Independent Health Agent to find the right dental plan that’s most affordable for your needs.