Medical or dental insurance covers oral surgery in many cases, but there are also some exceptions. Before you decide on the right treatment for you, you should know what’s covered and what isn’t, and what your out-of-pocket costs will be so you can budget correctly.
Is it Medically Necessary?
To find out whether medical or dental insurance covers oral surgery, it’s important to know if it is medically necessary.
You might think it’s more common for dental insurance to cover oral surgery, but it’s actually the opposite. Since many oral and maxillofacial procedures are serious and extensive, it’s likely your medical insurance may subsidize the costs, but first they will need to establish the reason for the surgery.
If you’re the victim of an accident and need injury treatment of your jawbone, your medical insurance would cover the surgical costs. If you have a growth in your jaw that must be removed, medical insurance would pay. Whenever there is a non-biting accident, disease or defect causing other health issues, your medical insurance covers oral surgery to treat the root issue.
On the other hand, oral surgery to treat periodontal disease or to prepare your jaw for implants isn’t required for medical reasons, so your claim would probably not go through.
What About Wisdom Teeth?
When wisdom teeth are impacted, your medical insurance may pay for removal because taking the teeth out is the only way to prevent infection and treat side effects. If your wisdom teeth aren’t yet impacted, your health insurance won’t help — you will need dental coverage to avoid paying all of the costs.
What About Anesthesia?
Medical insurance covers oral surgery sedation when it’s deemed medically necessary. If local anesthesia will be ineffective for the procedure in question, general anesthesia will be covered. Your policy likely has a list of conditions that qualify for this type of sedation.
What About Restorations?
It’s rare to get health insurance to cover the cost of dental implants. Dental implants are designed to enhance appearance and feel. They are not medically necessary, so you won’t likely receive medical insurance reimbursement.
If you were in an accident, your health insurance may pay for dentures, bridges or crowns. All other situations will not be covered, unless you can prove it is medically necessary.
Call Your Providers
To find out exactly what’s covered and what isn’t, call both your medical and dental insurance providers and get the details on your policy. At Northeast Oral & Maxillofacial Surgery, we help create affordable monthly payment plans while you wait for reimbursement. When insurance covers oral surgery, you have a much lighter burden, but either way our team works to make care affordable when you need it.