There is a common question that people have about oral surgery, which is “Is it a dental or medical procedure?” The mere fact that a procedure takes place at a dental or oral surgeon’s office does not mean it isn’t medical. Most states and the federal government recognize that oral surgeons provide more than just what some may consider dental care. If the procedure performed is medical rather than just dental, you can bill your medical insurance. 

Dental insurance usually covers routine cleanings at 100%, but only pays a small fraction of the cost of other treatments. Also, dental insurance usually has a low annual maximum benefit, so patients with complex dental needs can quickly exhaust their dental benefits. Patients with medical and dental issues can benefit from claiming medical insurance for procedures.

When is an oral surgery procedure medical?
When an oral surgery procedure is used to diagnose or treat a medical condition, it is considered medical. An overbite, for example, is a dental condition and not a medical condition. “Abscessed tooth” refers to both a dental and medical condition. “Diabetes” refers to a medical condition. Using the following information, you will better understand how you may be able to use your medical insurance to pay for some of your oral surgery or dental procedures.

Wisdom Teeth
Your health insurance plan will likely cover the cost of impacted wisdom tooth removal since the procedure is often medically necessary. There is a possibility that third molars can cause pain, infection, and cysts to form.

Your oral surgeon’s classification of wisdom teeth can affect your claim payment.

• Soft-Tissue Impaction-Less Likely to be Covered by Medical
• Partial Bony Impaction-More Likely to be Covered by Medical
• Complete Bony Impaction-Most likely to be covered by medical

Jaw Surgery
Depending on your insurance plan, you might be covered for orthognathic jaw surgery when it is medically necessary to treat an illness, injury, condition, disease, or its symptoms.

You can have operations on your jaw for a variety of reasons, and some of them fit into the coverage criteria exactly, some do not, and others fall somewhere in between.

Removal of Tori
A benign bone growth in the mouth, also known as a “torus” (plural), is a type of benign bone growth in the mouth. Tori removal (torus palatinus or torus mandibularis) is unlikely to be covered by health insurance because the removal of the excess jaw bone is rarely medically necessary.

Oral surgeons can bill your dental insurance plan, or you may pay out-of-pocket. Tori does not cause pain or cause other medical complications if left untreated.

Dental implants
Your dental implants may be covered by your health insurance if they are medically necessary for evaluating and treating a disease, condition, illness, or injury according to the applicable standard of care.

As an example, implants could be used to replace teeth lost during a covered accident or illness.

You shouldn’t have to navigate the complicated world of insurance alone. You can obtain specific benefit information about your dental and medical insurance plans from our oral surgery office. Please call us today to schedule an appointment.