You’ve just come out of a Houston dental clinic, and they’ve just told you that you need dental oral surgery. Your stomach drops. You’re already thinking about the cost, wondering if your insurance will cover it, and trying to figure out how you’ll pay for it all.
Sometimes, your medical insurance covers some dental oral surgeries. Yes, you read that right.
When Does Medical Insurance Cover Dental Oral Surgery?
If your dental oral surgery is medically necessary (not just for cosmetic reasons or routine dental care), your medical insurance might cover it.
Medical insurance typically kicks in when the surgery involves your overall health, not just your teeth. Think about it this way: if the problem could affect your ability to eat, breathe, or function normally, it’s more likely to be considered a medical issue.
Some examples include jaw surgery to fix a severe misalignment that’s causing pain, removing impacted wisdom teeth that are infected, or treating oral cancer. These aren’t just “dental problems.” They’re medical conditions that happen to be in your mouth.
What Types of Dental Oral Surgery Get Medical Coverage?
Jaw surgery for conditions like TMJ disorders or severe misalignment often qualifies. If you can’t chew properly or you’re in constant pain, that’s a medical issue.
Wisdom teeth removal can be covered if the teeth are impacted, infected, or causing other medical problems. Just getting them pulled because your dentist thinks it’s a good idea? That’s probably dental insurance territory.
Oral cancer treatment and biopsies are almost always covered by medical insurance because they’re clearly medical conditions.
Surgery after an accident or injury to your face or jaw typically falls under medical coverage too.
Sleep apnea surgery that involves your jaw or mouth structure can qualify for medical insurance coverage.
Routine extractions, dental implants for missing teeth, and cosmetic procedures usually don’t make the cut for medical insurance coverage.
How Do You Find Out If Your Dental Oral Surgery Is Covered?
You need to talk to your Houston dentist or oral surgeon. They’ve dealt with insurance companies before and can tell you if your case typically qualifies for medical coverage. They’ll look at your specific situation and give you their honest opinion.
Next, call your medical insurance company directly. Get the details in writing if possible. Ask them these specific questions:
- Does my plan cover dental oral surgery for my specific condition?
- What documentation do I need from my doctor?
- Do I need pre-authorization before the oral surgery?
- What’s my out-of-pocket cost for oral surgery going to be?
Write down the name of the person you talk to and the date. Keep notes. Insurance companies can be frustrating, and having a record helps if there’s a dispute later.
Your dentist’s office can also help by submitting a pre-determination to your insurance. This isn’t a guarantee, but it gives you a better idea of what they’ll actually pay.
What If Your Insurance Won’t Cover Oral Surgery?
Sometimes, the answer is no. For some oral surgeries, your medical insurance won’t provide any coverage, and your dental insurance has limits or won’t cover it either.
But many dental practices in Houston offer payment plans that let you spread out the cost over time. That makes a big expense feel more manageable.
Some people use healthcare credit cards like CareCredit. Just watch out for the interest rates and read the fine print.
You can also ask your dentist if there’s a less expensive way to handle your situation. Sometimes, there are alternative treatments that cost less but still solve the problem.
Get in Touch with All Stars Dental
At All Stars Dental, we’ve helped countless Houston residents walk through dental insurance and medical coverage for dental oral surgery.
When you come to us, we’ll review your insurance benefits with you and help you understand what’s covered and what’s not. We’ll work with your insurance company to get the documentation they need. And if you need dental oral surgery that isn’t fully covered, we’ll work with you on payment options that fit your budget.
We want you to get the dental care you need without the financial stress keeping you up at night.
Give us a call, and let’s figure this out together. You don’t have to navigate this alone.
Frequently Asked Questions
Will my dental insurance cover oral surgery if my medical insurance doesn’t?
Maybe. Dental insurance often covers a portion of oral surgery, but there are usually annual limits. Check your specific plan to see what’s covered and what your out-of-pocket costs might be.
How long does it take to find out if my insurance will cover my oral surgery?
It typically takes one to three weeks to get a pre-determination from your insurance company. Your Houston dentist can help speed this up by submitting all the necessary documentation right away.
Can I appeal if my medical insurance denies coverage for my dental oral surgery?
Yes, absolutely. If your medical insurance denies coverage and you believe the surgery is medically necessary, you have the right to appeal. Your local dentist can provide additional documentation and letters of medical necessity to support your case.