Is Oral Surgery Covered By Medical or Dental Insurance?

If you’re planning a major oral surgery such as wisdom teeth removal, you may wonder if your medical insurance can cover your dental treatment. The answer is possibly. Depending on the procedure, your medical insurance may cover a portion or all of the expense. Let’s dive into what constitutes a medical or dental procedure and what type of insurance (medical or dental insurance) covers it.

Medical Insurance vs. Dental Insurance: Who Decides?

Both medical and dental insurance claims use specific codes to describe the service performed. These codes outline the type of surgery, the difficulty of the surgery, which tooth is involved, and whether anesthesia or sedation is involved, among other factors. Your specific insurance policy terms determine which codes are and aren’t covered and at what percentage.

Do I Need to See an Oral Surgeon?

Seeing an oral surgeon is a good way to determine if one of your plans covers a particular procedure. Processing medical insurance claims is different from dental claims, so you need to visit a specialist like an oral surgeon who has experience in filing medical claims. Additionally, the practice’s treatment coordinator will break down your benefits, so you’ll know which services are covered, who will cover them, and how much your insurance company will pay.

When Will Medical Insurance Cover Oral Surgery?

If a procedure is considered medically necessary, you may have the option to file a claim with your medical insurance. This means the oral surgery must be required for your body’s overall health and wellness. For example, a problematic wisdom tooth surgery might require more than the standard dental procedures to complete the extraction successfully. Most of the time, however, medical insurance doesn’t cover dental procedures.

Which Dental Procedures Are Billed as Medical Procedures?

Four common types of dental procedures may be billed as medical procedures. These include:

Diagnostic Procedures

These procedures are used to diagnose a medical condition. For example, an X-ray to find the location of your impacted teeth might be considered a medical diagnostic procedure. Other examples include medical imaging, bacterial testing, models, stents, examinations, and consultations.

Non-surgical Medical Procedures

If it treats a medical condition, a non-surgical procedure unrelated to a traumatic injury may be billed as a medical procedure. Some examples include incisions and drainage of abscesses, emergency treatments for infection and inflammation, and TMJ and sleep apnea appliances.

Surgical Treatments

Surgical treatments can usually be billed as medical procedures. Examples include soft and hard tissue biopsies, cancer-related treatments, complicated wisdom tooth extractions, and medically necessary tooth removals.

Treatment for Dental or Facial Trauma

Treatment for traumatic dental or facial injuries — e.g., car accidents — can be billed as medical procedures. However, depending on the circumstances, you may want to check if your auto, homeowners, or other liability insurance can cover the injury. They may or may not provide better coverage than your medical insurance.

Always check with your dental or medical care provider to ensure which coverage can be billed for what procedure. The above is just a general guide.

Finding Ways to Save on Oral Surgery

If you need oral surgery, your medical insurance may cover the procedure, depending on your situation. However, you may also want to consider a dental savings plan. These plans are a trusted alternative to dental insurance that provide discounts on virtually all dental procedures, including oral surgery. Plan members save an average of 50%* on their dental care.

While traditional dental insurance has deductibles, annual caps, waiting periods, and restrictions around pre-existing conditions, dental savings plans do not. Want to learn more about dental savings plans? Call us at 1-833-735-0399 or use our calculator below to see how much you can save on your oral surgery and more with a dental savings plan.

_{*Discount Health Program consumer and provider surveys indicate average savings of 50%. Savings may vary by provider, location, and plan.}