When you need jaw surgery, the last thing you want to deal with is your insurance company. Endless phone calls and paperwork will add to the stress of your recovery, so it’s best to determine your coverage beforehand.
Should you depend on your health or dental insurance for jaw surgery coverage?
What Does Oral & Maxillofacial Surgery Entail?
When you visit an oral and maxillofacial surgeon, you’re trusting him or her to treat and correct injuries and conditions of the jaw, mouth, teeth, face, head and neck. One of the most common operations oral surgeons perform is corrective jaw surgery, but they also do extractions, bone grafts and more. They are usually licensed to administer anesthesia as well.
What Is a Medically Necessary Procedure?
If you’re electing to see an oral surgeon for cosmetic reasons, neither health nor dental plans are likely to pick up the bill. Corrective jaw surgery is sometimes performed to improve the look of the face, and this is not considered a medically necessary procedure.
On the other hand, surgery is often needed to restore facial structure after an injury or accident, or to address a chronic health problem that, if left untreated, could result in years of additional necessary treatment.
When it’s proven that surgery is medically necessary, your health insurance plan will likely cover all or at least a portion of the costs. Besides broken bones, fractures and damage from accidents, some examples of conditions that sometimes result in full insurance coverage may include:
- Jaw surgery to correct a speech defect caused by a cleft palate
- Jaw surgery to treat obstructive sleep apnea
- Chronic deformities that lead to chewing and jaw movement dysfunction
Some procedures, such as correction of temporomandibular joint disorder, could in some cases be deemed medically necessary, and in other cases are not. Wisdom tooth removal may be medically necessary if the teeth are impacted, but could be classified as elective if they are not. Consult with your oral surgeon before you present a case to your health insurance provider.
In addition, if your health insurance plan deems anesthesia medically necessary for the procedure, it will pay the associated costs for this treatment as well.
How to Get Coverage
You can call and talk to your insurance provider directly, but be aware that you probably won’t discuss your case with an expert in the field of oral surgery. The best approach is to get a free consult with your oral surgeon and have a member of their staff contact your provider to inquire about coverage.
Whether your health insurance or dental insurance covers the costs will depend on the details outlined in your personal plan, but you can trust that Northeast Oral & Maxillofacial Surgery will be with you every step of the way, helping you get the jaw surgery coverage you need.