For an insurance to cover oral surgery, there are several factors involved. Like other types of surgical procedures, the surgeon, location, type of procedure, and how much is involved in the procedure will influence how much it costs. Here are a few tips for determining if your insurance covers oral surgery
Which Plan Covers Oral Surgery: Medical or Dental?
Oral surgery can be tricky to cover because it involves both types of care, which are often covered with different policies. Medical and dental companies have strict guidelines on what insurance covers in oral surgery, and one may not pay for what the other does not cover, which can lead to expensive out of pocket costs if you go ahead without knowing what your plans provide.
Some insurance companies use different reimbursement rates for medical and dental insurance plan patients; therefore, there’s no easy answer as to if medical or dental insurance covers oral surgery. The most practical solution is to call both of your insurance providers for their individual information.
What Does Insurance Cover for Oral Surgery?
All health insurance plans are different, but as a general rule, insurance covers oral surgery for oral medical conditions, but not for dental services or enhancements.
- Some conditions insurance covers for oral surgery include tooth infections, abscesses of the mouth that are not of dental origin; new or unusual growth in the jaw, cheek or other hard or soft tissue in your mouth; or any cysts in your mouth that your oral surgeon or dentist suspects to be cancerous.
- Some conditions insurance may not cover for oral surgery include tooth extractions, treatment of periodontal disease, cysts that interfere with your child’s teeth coming through; treatment to prepare your mouth for dentures; dental reconstruction, prosthesis, or dental implants.
Your plan may be different, or may reimburse these procedures at different rates, so it’s always best to talk to your insurance company and find out if insurance covers the oral surgery procedures you’re anticipating.
Ask for an estimate from your oral surgeon with details on the type of procedure you’re expecting, which will help your insurance company determine if it is covered.
Keep in mind that you may have several different bills from different organizations, including anesthesia charges or surgical center fees.
How do I Get Reimbursed when Insurance Covers Oral Surgery?
The financial staff at your oral surgeon’s office is specially trained to make reimbursement for insurance claims fast and easy as possible. Although patients are normally responsible for the fees regardless of insurance coverage, most oral surgery clinics work with patients to develop a payment plan to help the patient pay for out of pocket charges.
Patients at Oral & Maxillofacial Surgery or Utah can expect the best care and the most cost-effective financial solutions. Our team of professionals walks patients through insurance reimbursements, as well as helps create an affordable monthly payment plan.